Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Payer policies and prior authorization for C1603
Medicaid fee-for-service
IN: $0.00 (professional, facility), effective Jan 1, 2024
KY: $0.00 (asc), effective Jan 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.