43333 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 43333

Payer coverage policies that name 43333

43333 appears in 4 coverage policies from Aetna, Anthem, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaLung Transplantation (0598)not coveredSep 8, 2026payer document
AetnaObesity Surgery (0157)listed, no stanceJul 21, 2026payer document
AnthemParaesophageal Hernia Repair (CG-SURG-92)covered if criteria are metNov 6, 2025payer document
RegenceGastroesophageal Reflux Surgery (Surgery 186)
NOTES
listed, no stanceFeb 1, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in WV.

  • AZ: $1284.15 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $982.09 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $914.39 (physician, non-facility), effective Jan 1, 2026
  • IL: $887.72 (practitioner), effective Apr 1, 2024
  • IN: $942.72 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $545.50 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $1121.82 (physician, facility), effective Jan 1, 2026
  • LA: $1026.04 (professional), effective Jul 1, 2025
  • MA: $916.44 (physician_surgery), effective May 1, 2024
  • MS: $978.63 (comprehensive), effective Jul 1, 2026
  • ND: $1201.20 (physician), effective Aug 1, 2026
  • NE: $2600.90 (physician, non-facility), effective Jul 1, 2026
  • NY: $499.51 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $672.24 (physician), effective Jan 1, 2024
  • OK: $1033.41 (physician, non-facility), effective Jul 1, 2026
  • TX: $138.51 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026
  • VA: $1018.52 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $676.88 (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.