80321 CPT® code: payer coverage and prior authorization9 of 13 payer prior-auth lists that name 80321 require prior authorization or set conditions: Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of Iowa, Molina Healthcare of Nevada, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Wisconsin.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Complete Care (Virginia) | Medicare-only PA matrix for D-SNP | VA | prior auth under conditions | PA after 12 dates of service | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022 |
| Molina Healthcare of Arizona | Medicare-only PA matrix for D-SNP | AZ | prior auth under conditions | PA after 12 dates of service | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022 |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth under conditions | PA after 12 dates of service | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth under conditions | PA after 12 dates of service | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth under conditions | PA after 12 units | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Ohio | Exchange | OH | prior auth under conditions | PA after 12 units | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Texas | Exchange | TX | prior auth under conditions | PA after 12 dates of service | Oct 1, 2021 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
| Molina Healthcare of Wisconsin | Medicare Advantage | WI | prior auth under conditions | PA after 12 dates of service | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021 |
80321 appears in 7 coverage policies from Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Centene, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Anthem | Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain (CG-LAB-09) | covered if criteria are met | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Urine Drug Testing | listed, no stance | payer document | |
| Blue Cross Blue Shield of Massachusetts | Drug Testing in Pain Management and Treatment of Substance Use Disorders (674) | listed, no stance | payer document | |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 80047-80439) | Mar 1, 2024 | payer document |
| BlueCross BlueShield of South Carolina | Prescription Medication and Illicit Drug Testing in the Outpatient Setting (CAM 140) Number | listed, no stance | Apr 1, 2026 | payer document |
| Centene | Drugs of Abuse: Definitive Testing (CP.MP.50) | covered if criteria are met | Jun 1, 2023 | payer document |
| Premera Blue Cross | Prescription Medication and Illicit Drug Testing in the Outpatient Setting | listed, no stance | Feb 6, 2026 | payer document |
Prior authorization required or conditional in IN, VT.
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.