Payer policies › CPT 9112491124 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 91124 Payer coverage policies that name 91124 91124 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: $66.18 (asc), effective Oct 1, 2026 CO: $19.19 (chp_plus, non-facility), effective Jul 1, 2026 FL: $597.73 (physician, facility), effective Jan 1, 2026 IL: $500.73 (practitioner), effective Jan 1, 2026 IN: $587.71 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $77.55 (asc, facility), effective Jan 1, 2026 KY: $617.67 (physician, facility), effective Jan 1, 2026 LA: $588.56 (professional), effective Jan 1, 2026 MS: $95.44 (comprehensive, facility), effective Jan 1, 2026 ND: $68.65 (physician, facility), effective Aug 1, 2026 NY: $670.44 (physician_medicine, facility), effective Jul 1, 2026 OH: $569.49 (code_changes), effective Jan 1, 2026 OK: $505.62 (physician, non-facility), effective Jul 1, 2026 TX: $615.60 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Jan 1, 2026 VA: $143.88 (medical, facility), effective Jan 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $479.47 (physician, facility), effective Jul 1, 2026 WY: $95.49 (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.