Payer policies › CPT 1313313133 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 13133 Payer coverage policies that name 13133 13133 appears in 3 coverage policies from Aetna, Anthem.
Payer Policy Role in policy Reviewed Document Aetna Gender Affirming Surgery (0615) covered if criteria are met Sep 8, 2026 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered (range 10040-19499) Jul 29, 2026 payer document Anthem Treatment of Keloids and Scar Revision (CG-SURG-31) covered if criteria are met (range 12031-13153) May 14, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in WA.
AZ: $45.78 (outpatient_hospital, RF133), effective Oct 1, 2024 CO: $104.38 (chp_plus, non-facility), effective Jul 1, 2026 FL: $180.66 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IN: $95.89 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $100.11 (default, Exempt Physician), effective Aug 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $182.30 (asc), effective Jul 1, 2012 MA: $0.00 (asc), effective May 1, 2026 MS: $138.14 (comprehensive), effective Jul 1, 2026 ND: $182.86 (physician), effective Aug 1, 2026 NE: $413.00 (asc), effective Jul 1, 2024 NY: $61.76 (physician_surgery, facility), effective Jul 1, 2026 OH: $66.24 (physician, facility), effective Jan 1, 2024 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $91.48 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2025 VA: $88.54 (medical, facility), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $59.62 (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.