Payer policies › CPT 1201312013 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 12013 Payer coverage policies that name 12013 12013 appears in 2 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Bone and Tendon Graft Substitutes and Adjuncts (0411) listed, no stance (range 12001-12021) Aug 18, 2026 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered (range 10040-19499) Jul 29, 2026 payer document
Medicaid fee-for-service AZ: $62.22 (outpatient_hospital, RF133), effective Oct 1, 2024 CO: $58.66 (chp_plus, non-facility), effective Jul 1, 2026 FL: $43.38 (physician, facility), effective Jan 1, 2026 IL: $58.86 (practitioner), effective Apr 1, 2024 IN: $43.59 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $324.00 (asc, facility), effective Aug 1, 1982 KY: $0.00 (asc), effective Jan 1, 2026 LA: $124.08 (professional), effective Feb 1, 2013 MA: $0.00 (asc), effective May 1, 2026 MS: $116.83 (comprehensive), effective Jul 1, 2026 MT: $55.77 (optometric, facility), effective Jul 1, 2025 ND: $157.71 (physician), effective Aug 1, 2026 NE: $72.25 (physician, facility), effective Jul 1, 2026 NY: $53.93 (nurse_practitioner, facility), effective Jul 1, 2026 OH: $41.80 (physician, facility), effective Jan 1, 2024 OK: $180.67 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $42.54 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2025 VA: $48.32 (medical, facility), effective Jul 1, 2026 VT: $155.78 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $31.72 (physician, facility), effective Jul 1, 2026 WY: $88.73 (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.