Payer policies › CPT 9917599175 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 99175 Medicaid fee-for-service AZ: $30.68 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $3.02 (chp_plus, non-facility), effective Jul 1, 2026 IN: $22.70 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $31.42 (default, Exempt Physician), effective Jul 1, 2023 KY: $38.10 (physician, facility), effective Jan 1, 2026 LA: $22.47 (professional), effective Jul 1, 2025 MA: $24.04 (physician_medicine), effective May 1, 2024 MS: $35.42 (comprehensive), effective Jul 1, 2026 ND: $51.07 (physician), effective Aug 1, 2026 NE: $38.38 (physician, non-facility), effective Jul 1, 2026 OH: $15.00 (physician), effective Jan 1, 2024 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 VA: $39.64 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $28.86 (physician, facility), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.