Payer policies › CPT 9102291022 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 91022 Payer coverage policies that name 91022 91022 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Gastrointestinal Manometry (0616) covered if criteria are met Sep 3, 2026 payer document
Medicaid fee-for-service AZ: $64.65 (asc), effective Oct 1, 2026 CO: $85.85 (chp_plus, non-facility), effective Jul 1, 2026 FL: $87.88 (physician), effective Jan 1, 2026 IL: $118.09 (practitioner), effective Jul 1, 2026 IN: $132.92 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $115.34 (asc), effective Jan 1, 2026 LA: $145.33 (professional), effective Feb 1, 2013 MA: $133.68 (physician_medicine), effective May 1, 2024 ND: $114.08 (physician, facility), effective Aug 1, 2026 NE: $60.32 (physician, non-facility), effective Jul 1, 2026 NY: $50.50 (ordered_ambulatory), effective Jul 24, 2026 OH: $159.06 (physician), effective Jan 1, 2010 OK: $98.51 (physician, non-facility), effective Jul 1, 2026 TX: $85.04 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, facility), effective Sep 1, 2025 VA: $65.97 (medical), effective Jul 1, 2026 VT: $289.74 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $45.67 (physician, facility), effective Jul 1, 2026 WY: $165.02 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.