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PAYER POLICY CHANGES

A4413 Insurance Policy Changes

HCPCS A4413 is officially defined as "Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each." HCPCS A4413 is referenced in 2 tracked payer policy changes from BlueCross BlueShield of South Carolina and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS A4413 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Community Health Plan of Imperial Valley · Effective December 31, 2025

    Prior authorization required

    Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does AmeriHealth Caritas require prior authorization for A4413?

AmeriHealth Caritas lists A4413 on AmeriHealth Caritas Louisiana Act 233 prior authorization service list for medicaid managed plans, with conditions. Verify with the payer before scheduling.

Does CalViva Health require prior authorization for A4413?

CalViva Health lists A4413 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 Community Health Plan of Imperial Valley require prior authorization for A4413?

Community Health Plan of Imperial Valley lists A4413 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 HCPCS A4413?

There are 2 tracked policy changes affecting HCPCS A4413, including updates from BlueCross BlueShield of South Carolina, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS A4413?

Payers that have issued tracked updates for HCPCS A4413 include: BlueCross BlueShield of South Carolina, Aetna.

How do I get notified when HCPCS A4413 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS A4413. 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 HCPCS A4413?

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.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for A4413 in one place.

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