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PAYER POLICY CHANGES

L0113 Insurance Policy Changes

HCPCS L0113 is officially defined as "Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment." HCPCS L0113 is referenced in 4 tracked payer policy changes from Excellus BlueCross BlueShield and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS L0113 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 rules5
Payers requiring prior auth5
  • Colorado Medicaid · Effective July 1, 2026

    Prior authorization required

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

  • CountyCare Health Plan · Effective April 23, 2026

    Prior authorization required

    CountyCare Prior Authorization Look-Up Tool (All Codes)

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does AmeriHealth Caritas require prior authorization for L0113?

AmeriHealth Caritas lists L0113 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans, with conditions. Verify with the payer before scheduling.

Does CalViva Health require prior authorization for L0113?

CalViva Health lists L0113 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 Colorado Medicaid require prior authorization for L0113?

Colorado Medicaid lists L0113 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 L0113?

Community Health Plan of Imperial Valley lists L0113 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.

Does CountyCare Health Plan require prior authorization for L0113?

CountyCare Health Plan lists L0113 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans (list dated April 23, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS L0113?

There are 4 tracked policy changes affecting HCPCS L0113, including updates from Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS L0113?

Payers that have issued tracked updates for HCPCS L0113 include: Excellus BlueCross BlueShield, Aetna.

How do I get notified when HCPCS L0113 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS L0113. 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 L0113?

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 L0113

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for L0113 in one place.

See every payer rule

RELATED

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