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PAYER POLICY CHANGES

22513 Insurance Policy Changes

CPT 22513, in plain terms, covers Percutaneous vertebral augmentation such as balloon kyphoplasty, creating a cavity then filling it with cement, in one thoracic vertebral body. CPT 22513 is referenced in 5 tracked payer policy changes from Excellus BlueCross BlueShield, Regence BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 22513 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 22513 on AAPC

Watch 22513

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REFERENCE DATA

Payers with rules17
Payers requiring prior auth17
  • Aetna · Effective November 1, 2026

    Prior authorization required

    Participating provider precertification list for Aetna

  • Anthem BCBS · Effective November 1, 2026

    Prior authorization required

    Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)

  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 22513?

Aetna lists 22513 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Ambetter require prior authorization for 22513?

Ambetter lists 22513 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 22513?

Anthem BCBS lists 22513 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 22513?

BCBS Arizona lists 22513 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 22513?

BCBS Illinois lists 22513 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 22513?

There are 5 tracked policy changes affecting CPT 22513, including updates from Excellus BlueCross BlueShield, Regence BlueShield, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 22513?

Payers that have issued tracked updates for CPT 22513 include: Excellus BlueCross BlueShield, Regence BlueShield, Humana, Sentara Health Plans, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 22513 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 22513. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 22513?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 22513

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 22513 in one place.

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