Payer policies › CPT 9468194681 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 94681 Payer coverage policies that name 94681 94681 appears in 6 coverage policies from Aetna, Centene.
Payer Policy Role in policy Reviewed Document Aetna Allergy and Hypersensitivity (0038) covered if criteria are met Mar 10, 2026 payer document Aetna Allergy and Hypersensitivity (0038) listed, no stance Mar 10, 2026 payer document Aetna Benralizumab (Fasenra) (0925) listed, no stance (range 94010-94799) Aug 25, 2026 payer document Aetna Oxygen (0002) listed, no stance (range 94010-94777) Mar 10, 2026 payer document Aetna Pulmonary Rehabilitation (0032) listed, no stance (range 94640-94799) Mar 5, 2026 payer document Aetna Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479) listed, no stance (range 94642-94799) Jul 9, 2026 payer document Centene Pulmonary Function Testing (CP.MP.242)Codes6-7 covered if criteria are met payer document
Medicaid fee-for-service AZ: $191.73 (outpatient_hospital), effective Oct 1, 2021 CO: $40.43 (chp_plus, non-facility), effective Jul 1, 2026 FL: $7.53 (physician), effective Jan 1, 2026 IL: $44.04 (practitioner), effective Apr 1, 2024 IN: $36.58 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $51.00 (default, Exempt Physician), effective Jun 1, 2006 KY: $52.38 (physician, facility), effective Jan 1, 2026 LA: $40.20 (professional), effective Feb 1, 2013 MA: $29.86 (physician_medicine), effective May 1, 2024 MS: $39.81 (comprehensive), effective Jul 1, 2026 ND: $55.57 (physician), effective Aug 1, 2026 NE: $153.55 (physician, non-facility), effective Jul 1, 2026 NY: $25.25 (ordered_ambulatory), effective Jul 24, 2026 OH: $46.62 (physician), effective Sep 1, 2013 OK: $8.73 (physician, non-facility), effective Jul 1, 2026 TX: $31.01 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Sep 1, 2025 VA: $43.40 (medical), effective Jul 1, 2026 VT: $289.74 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $5.73 (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.