Question 1

What insurance policy changes affect CPT 97113?

Accepted Answer

There are 2 tracked policy changes affecting CPT 97113, including updates from Sentara Health Plans, CareSource. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 97113?

Accepted Answer

Payers that have issued tracked updates for CPT 97113 include: Sentara Health Plans, CareSource.

Question 3

How do I get notified when CPT 97113 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 97113. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 97113?

Accepted Answer

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.

97113 Insurance Policy Changes

Authorization Updates - Effective January 1, 2026

[Georgia] Prior Authorization Requirement Update