90733 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90733

Payer coverage policies that name 90733

90733 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina.

PayerPolicyRole in policyReviewedDocument
AetnaInjectable Medications (0020)listed, no stance (range 90713-90749)Mar 5, 2026payer document
AetnaMeningococcal Vaccines (0356)covered if criteria are metMay 22, 2026payer document
Blue Cross & Blue Shield of Rhode IslandImmunizations Adult and Pediatric
MEDICAL COVERAGE POLICY | 8		covered if criteria are metJun 9, 2026payer document
BlueCross BlueShield of South CarolinaPreventive Services for Non-Grandfathered (PPACA) Plans: Immunizations (CAM 109)listed, no stanceApr 1, 2026payer document

Medicaid fee-for-service

  • CO: $130.67 (chp_plus_immunizations), effective Jul 1, 2026
  • IN: $0.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KY: $106.49 (physician, non-facility), effective Jan 1, 2026
  • MS: $106.49 (comprehensive), effective Jul 1, 2020
  • ND: $0.00 (physician), effective Aug 1, 2026
  • OH: $106.49 (provider_administered_drugs), effective Feb 1, 2015
  • OK: $164.75 (physician, non-facility), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $116.30 (professional_administered_drugs), 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.