Payer policies › CPT 9224292242 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 92242 Payer coverage policies that name 92242 92242 appears in 4 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Cranial Remodeling (0379) not covered May 26, 2026 payer document Aetna Hyperbaric Oxygen Therapy (HBOT) (0172) listed, no stance Apr 21, 2026 payer document Aetna Indocyanine Green Angiography (0111) covered if criteria are met Mar 18, 2026 payer document Aetna Optic Nerve and Retinal Imaging Methods (0344) listed, no stance Sep 1, 2026 payer document
Medicaid fee-for-service AZ: $191.73 (outpatient_hospital), effective Oct 1, 2021 CO: $218.17 (chp_plus, non-facility), effective Jul 1, 2026 FL: $39.10 (physician), effective Jan 1, 2026 IL: $178.56 (practitioner), effective Apr 1, 2024 IN: $42.24 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $45.00 (asc), effective Jan 1, 2026 LA: $62.38 (professional), effective Jan 1, 2017 MA: $40.40 (physician_medicine), effective May 1, 2024 MS: $46.48 (comprehensive), effective Jul 1, 2020 MT: $314.23 (optometric, facility), effective Jul 1, 2025 ND: $60.08 (physician), effective Aug 1, 2026 NE: $126.13 (physician, non-facility), effective Jul 1, 2026 NY: $58.85 (ordered_ambulatory), effective Jul 24, 2026 OH: $196.64 (physician), effective Jan 1, 2024 OK: $284.19 (physician, non-facility), effective Jul 1, 2026 TX: $40.80 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2023 VA: $291.38 (medical), effective Jul 1, 2026 VT: $167.66 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $210.78 (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.