13153 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 13153

1 of 1 payer prior-auth lists that name 13153 require prior authorization or set conditions: UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
UnitedHealthcare Community PlanMaryland HealthChoiceMDprior auth under conditionsonly with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890Sep 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026

Payer coverage policies that name 13153

13153 appears in 2 coverage policies from Aetna, Anthem.

PayerPolicyRole in policyReviewedDocument
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 10040-19499)Jul 29, 2026payer document
AnthemTreatment of Keloids and Scar Revision (CG-SURG-31)covered if criteria are met (range 12031-13153)May 14, 2026payer document

Medicaid fee-for-service

  • AZ: $52.21 (outpatient_hospital, RF133), effective Oct 1, 2024
  • CO: $113.32 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $196.31 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IN: $104.47 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $0.00 (asc), effective May 1, 2026
  • MS: $96.37 (comprehensive), effective Jul 1, 2026
  • ND: $204.64 (physician), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $67.87 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $71.46 (physician, facility), effective Jan 1, 2024
  • OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $104.58 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2025
  • VA: $98.38 (medical, facility), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $65.93 (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.