96373 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 96373

Payer coverage policies that name 96373

96373 appears in 8 coverage policies from Aetna, Blue Shield of California.

PayerPolicyRole in policyReviewedDocument
AetnaClotting Factors (0131)listed, no stance (range 96365-96379)Apr 23, 2026payer document
AetnaHistamine Desensitization Therapy for Intractable Headaches (0647)listed, no stance (range 96365-96379)Sep 14, 2026payer document
AetnaInjectable Medications (0020)listed, no stance (range 96365-96379)Mar 5, 2026payer document
AetnaMyalgic Encephalomyelitis - Chronic Fatigue Syndrome (ME/CSF) (0369)listed, no stanceMay 20, 2026payer document
AetnaPost-Herpetic Neuralgia (0725)listed, no stance (range 96365-96379)Oct 20, 2025payer document
AetnaSomatostatin Analogs (0693)listed, no stance (range 96361-96379)Jul 15, 2026payer document
AetnaTrigeminal Neuralgia: Treatments (0374)listed, no stanceJun 29, 2026payer document
Blue Shield of California| Monitored Anesthesia Care (7.02.01)listed, no stancepayer document

Medicaid fee-for-service

  • AZ: $147.54 (outpatient_hospital), effective Oct 1, 2021
  • CO: $15.09 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $15.33 (physician, non-facility), effective Jan 1, 2026
  • IL: $12.16 (practitioner), effective Apr 1, 2024
  • IN: $14.70 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $9.39 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $45.00 (asc), effective Jan 1, 2026
  • MA: $14.00 (physician_medicine), effective May 1, 2024
  • MS: $161.53 (comprehensive), effective Jul 1, 2026
  • ND: $21.78 (physician), effective Aug 1, 2026
  • NE: $15.34 (physician, non-facility), effective Jul 1, 2026
  • OH: $14.18 (physician), effective Jan 1, 2009
  • OK: $191.54 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $14.02 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2026
  • VA: $17.07 (medical), effective Jul 1, 2026
  • VT: $165.16 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $12.04 (physician, facility), effective Jul 1, 2026
  • WY: $94.07 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.