38213 CPT® code: payer coverage and prior authorization71 of 72 payer prior-auth lists that name 38213 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Texas, Cigna, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Neighborhood Health Partnership, Oxford Health Plans, Passport by Molina Healthcare (Kentucky), Rocky Mountain Health Plans, and others.
38213 appears in 108 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (0780) | listed, no stance (range 38208-38215) | Apr 27, 2026 | payer document |
| Aetna | Alpha1-Proteinase Inhibitors (0145) | listed, no stance (range 38207-38215) | Mar 24, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | not covered (range 38206-38215) | Oct 2, 2025 | payer document |
| Aetna | Bendamustine Products (0875) | listed, no stance (range 38204-38215) | Sep 15, 2026 | payer document |
| Aetna | Donor Lymphocyte Infusion (0638) | covered if criteria are met (range 38207-38230) | Sep 29, 2026 | payer document |
| Aetna | Erythropoiesis Stimulating Agents (0195) | not covered (range 38204-38232) | Jan 20, 2026 | payer document |
| Aetna | Etuvetidigene Autotemcel (Waskyra) (1097) | listed, no stance | Oct 5, 2026 | payer document |
| Aetna | Extracorporeal Photochemotherapy (Photopheresis) (0241) | listed, no stance (range 38204-38230) | Apr 13, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Aplastic Anemia and other Bone Marrow Failure Syndromes (0627) | listed, no stance (range 38204-38215) | Sep 23, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (0606) | not covered (range 38207-38215) | Sep 18, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Chronic Myelogenous Leukemia (0674) | listed, no stance (range 38204-38215) | Oct 7, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Hodgkin's Disease (0495) | covered if criteria are met | Jul 2, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Inherited Metabolic Disorders and Genetic Diseases (0871) | covered if criteria are met (range 38207-38215) | Dec 22, 2025 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Multiple Myeloma (0497) | listed, no stance (range 38207-38215) | Aug 5, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Myelodysplastic Syndrome (0836) | listed, no stance (range 38207-38220) | Dec 9, 2025 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Myelofibrosis (0838) | covered if criteria are met (range 38207-38215) | Dec 9, 2025 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Non-Hodgkin's Lymphoma (0494) | listed, no stance (range 38204-38215) | Aug 3, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Ovarian Cancer (0635) | listed, no stance (range 38206-38215) | Sep 11, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Selected Childhood Solid Tumors (0496) | listed, no stance (range 38204-38215) | Aug 6, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Selected Leukemias (0640) | covered if criteria are met (range 38206-38215) | Sep 11, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Solid Tumors in Adults (0811) | not covered (range 38207-38215) | Dec 3, 2025 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Testicular Cancer (0617) | covered if criteria are met (range 38206-38230) | Sep 3, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia (0626) | listed, no stance (range 38206-38215) | Sep 18, 2026 | payer document |
| Aetna | Hypoxic Ischemic Encephalopathy (0812) | not covered (range 38207-38215) | Nov 20, 2025 | payer document |
| Aetna | Marnetegragene Autotemcel (Kresladi) (1102) | listed, no stance (range 38207-38215) | Jul 13, 2026 | payer document |
| Aetna | Multiple Sclerosis (0264) | not covered | Sep 10, 2026 | payer document |
| Aetna | Narsoplimab-wuug (Yartemlea) (1099) | listed, no stance | Apr 27, 2026 | payer document |
| Aetna | Non-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (0634) | covered if criteria are met (range 38207-38215) | Sep 25, 2026 | payer document |
| Aetna | Pegzilarginase-nbln (Loargys) (1101) | listed, no stance | Jun 26, 2026 | payer document |
| Aetna | Stem Cells for Hematopoietic Cell Transplant (0190) | covered if criteria are met | Mar 27, 2026 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors (TRANS.00031) | covered if criteria are met (range 38207-38215) | May 14, 2026 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors (TRANS.00031) | unproven / investigational (range 38207-38215) | May 14, 2026 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Diabetes Mellitus (TRANS.00034) | unproven / investigational (range 38207-38215) | Nov 6, 2025 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias (TRANS.00029) | covered if criteria are met (range 38207-38215) | Nov 6, 2025 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias (TRANS.00029) | unproven / investigational (range 38207-38215) | Nov 6, 2025 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Germ Cell Tumors (TRANS.00030) | covered if criteria are met (range 38207-38215) | Nov 6, 2025 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Germ Cell Tumors (TRANS.00030) | unproven / investigational (range 38207-38215) | Nov 6, 2025 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Hodgkin Disease and non-Hodgkin Lymphoma (TRANS.00028) | covered if criteria are met (range 38207-38215) | May 14, 2026 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Multiple Myeloma and Other Plasma Cell Dyscrasias (TRANS.00023) | covered if criteria are met (range 38207-38215) | Nov 6, 2025 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Pediatric Solid Tumors (TRANS.00027) | covered if criteria are met (range 38207-38215) | Nov 6, 2025 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Select Leukemias and Myelodysplastic Syndrome (TRANS.00024) | covered if criteria are met (range 38207-38215) | Nov 6, 2025 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Select Leukemias and Myelodysplastic Syndrome (TRANS.00024) | unproven / investigational (range 38207-38215) | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Allogeneic Hematopoietic Cell Transplantation For Genetic Diseases And Acquired Anemias (L.8.01.412) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Allogeneic Hematopoietic Cell Transplantation For Myelodysplastic Syndromes And Myeloproliferative Neoplasms | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Autologous Hematopoietic Stemcell Transplantation For Malignant Astrocytomas And Gliomas (L.8.01.405) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Acute Lymphoblastic Leukemia | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Acute Myeloid Leukemia | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Autoimmune Diseases | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Chronic Lymphocytic Leukemiasmall Lymphocytic Lymphoma | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Chronic Myeloid Leukemia | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Cns Embryonal Tumors And Ependymoma | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Epithelial Ovarian Cancer | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Hodgkin Lymphoma | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Miscellaneous Solid Tumors In Adults | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Nonhodgkin Lymphomas | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Plasma Cell Dyscrasias Including Multiple Myeloma And Poems Syndrome | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Primary Amyloidosis Or Waldenstroms Macroglobulinemia | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Solid Tumors Of Childhood | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation In The Treatment Of Germ Cell Tumors | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Stemcell Transplantation For Breast Cancer (L.8.01.410) | not covered | payer document | |
| Blue Cross & Blue Shield of Mississippi | Nonmyeloablative Allogeneic Transplants Of Hematopoietic Stemcells For Treatment Of Malignancy (L.8.01.406) | covered if criteria are met | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (8.01.26) | listed, no stance | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation for Autoimmune Diseases (8.01.25) | listed, no stance | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (8.01.15) | listed, no stance | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (8.01.23) | listed, no stance | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation for Hodgkin Lymphoma (8.01.29) | listed, no stance | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (8.01.20) | listed, no stance | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (8.01.17) | listed, no stance | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation for Primary Amyloidosis (8.01.42) | listed, no stance | payer document | |
| Blue Shield of California | Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors (8.01.35) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (CAM 80121) | listed, no stance | Jul 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Cell Transplantation for Breast Cancer (CAM 80127) | listed, no stance | Jul 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (CAM 80123) | listed, no stance | Jul 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (CAM 80124) | listed, no stance | Jul 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (CAM 80117) | listed, no stance | Jan 1, 2026 | payer document |
| Capital Blue Cross | Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (MP 9.056) Procedure codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (MP 9.041) Procedure codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Autoimmune diseases (MP 9.053) Procedure codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for CNS Embryonal Tumors and Ependymoma (MP 9.050) Procedure codes | covered if criteria are met | May 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (MP 9.038) Procedure codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (MP 9.039) Procedure codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (MP 9.047) Procedure codes | unproven / investigational | May 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Hodgkin Lymphoma (MP 9.043) Procedure codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (MP 9.048) Procedure codes | unproven / investigational | May 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (MP 9.042) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and Poems Syndrome (MP 9.044) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Primary Amyloidosis (MP 9.045) Procedure codes | covered if criteria are met | May 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Solid Tumors of Childhood (MP 9.054) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation in the Treatment of Germ-Cell Tumors (MP 9.052) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Centene | Nonmyeloablative Allogeneic Stem Cell Transplants Reference Number: CP.MP.141 (CP.MP.141) | covered if criteria are met | Jan 1, 2026 | payer document |
| Cigna | Stem Cell Transplantation: Blood Cancers (0533) | covered if criteria are met | Aug 15, 2026 | payer document |
| Cigna | Stem Cell Transplantation: Non-Cancer Disorders (0535) | covered if criteria are met | Jan 15, 2026 | payer document |
| Cigna | Stem Cell Transplantation: Solid Tumors (0534) | covered if criteria are met | Jan 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (SUR703.032) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, | listed, no stance | May 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (SUR703.043) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212, | listed, no stance | Sep 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (SUR703.037) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212, | listed, no stance | Aug 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hematopoietic Cell Transplantation for Autoimmune Diseases (SUR703.036) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, | listed, no stance | Jun 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hematopoietic Cell Transplantation for Breast Cancer (SUR703.038) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, | listed, no stance | May 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma (SUR703.039) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, | listed, no stance | Sep 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) (SUR703.029) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212, | listed, no stance | May 15, 2026 | payer document |
Prior authorization required or conditional in IN.
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.