Payer policies › CPT 9103091030 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 91030 Medicaid fee-for-service AZ: $62.81 (asc), effective Oct 1, 2026 CO: $35.53 (chp_plus, non-facility), effective Jul 1, 2026 FL: $35.43 (physician), effective Jan 1, 2026 IL: $93.51 (practitioner), effective Apr 1, 2024 IN: $35.81 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $31.87 (default, Exempt Physician), effective Aug 1, 2024 KY: $112.06 (asc), effective Jan 1, 2026 LA: $35.05 (professional), effective Feb 1, 2013 MA: $33.80 (physician_medicine), effective May 1, 2024 MS: $129.84 (comprehensive), effective Jul 1, 2026 ND: $110.84 (physician, facility), effective Aug 1, 2026 NE: $24.67 (physician, non-facility), effective Jul 1, 2026 NY: $60.60 (ordered_ambulatory), effective Jul 24, 2026 OH: $77.82 (physician), effective Jan 1, 2024 OK: $95.72 (physician, non-facility), effective Jul 1, 2026 TX: $120.69 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Sep 1, 2025 VA: $140.91 (medical), effective Jul 1, 2026 VT: $289.74 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $28.86 (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.