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PAYER POLICY CHANGES

92313 Insurance Policy Changes

CPT 92313, in plain terms, covers The physician measures, designs, and fits a corneoscleral rigid contact lens. CPT 92313 is referenced in 2 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92313 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 92313 on AAPC

Watch 92313

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REFERENCE DATA

Payers with rules5
Payers requiring prior auth5
  • Colorado Medicaid · Effective July 1, 2026

    Prior authorization required

    Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column)

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Louisiana Healthcare Connections CMS-0057-F prior authorization requirements

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 92313?

Ambetter lists 92313 on Ambetter from Louisiana Healthcare Connections CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 92313?

CalViva Health lists 92313 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for 92313?

Centene lists 92313 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Colorado Medicaid require prior authorization for 92313?

Colorado Medicaid lists 92313 on Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column) for medicaid ffs plans (list dated July 1, 2026). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 92313?

Community Health Plan of Imperial Valley lists 92313 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 92313?

There are 2 tracked policy changes affecting CPT 92313, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 92313?

Payers that have issued tracked updates for CPT 92313 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 92313 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 92313. 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 92313?

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 92313

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 92313 in one place.

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