15 commercial payer policies list Q4133. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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15 policies from 12 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Cigna Commercial Other Services Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Tissue Engineered Skin Substitutes | Jun 15, 2026 | Covered with conditions |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Skin and Tissue Substitutes | Jun 22, 2026 | Covered |
| Skin and Tissue Substitutes |
|---|
| May 25, 2026 |
| Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Skin and Soft Tissue Substitutes | Feb 9, 2024 | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Skin and Soft Tissue Substitutes | Not recorded | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses | Aug 27, 2026 | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Amniotic Membrane and Amniotic Fluid | Dec 15, 2025 | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Amniotic Membrane and Amniotic Fluid | Dec 15, 2025 | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Amniotic Membrane and Amniotic Fluid | Dec 15, 2025 | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Amniotic Membrane and Amniotic Fluid | Dec 15, 2025 | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Skin and Soft Tissue Substitutes | Aug 1, 2026 | Covered |
| Policy | Effective | Status of Q4133 |
|---|---|---|
| Skin and Soft Tissue Substitutes | Aug 1, 2026 | Covered |