`0197U` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0197U

Payer coverage policies that name 0197U

0197U appears in 4 coverage policies from Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Blue Cross NC	Red Blood Cell Molecular Testing AHS - M2170	listed, no stance	Sep 1, 2025	payer document
BlueCross BlueShield of South Carolina	Redblood Cell Molecular Testing (CAM 247)	listed, no stance	Jul 1, 2026	payer document
Cigna	Laboratory Testing Services (0604)	not covered	May 15, 2026	payer document
Premera Blue Cross	Laboratory Testing Investigational Services (2.04.520) Page \| 3 of 21 \| ∞	unproven / investigational	Oct 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, MS.

AZ: $185.20 (lab), effective Oct 1, 2026
FL: $100.01 (lab_independent, non-facility), effective Jan 1, 2026
KY: $185.20 (lab), effective Jan 1, 2026
MS: $166.68 (comprehensive), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

0197U CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0197U

Payer coverage policies that name 0197U

Medicaid fee-for-service

`0197U` CPT® code: payer coverage and prior authorization