80374 CPT® code: payer coverage and prior authorization8 of 10 payer prior-auth lists that name 80374 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 | 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 |
80374 appears in 8 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, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), 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 |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Drug Testing in Pain Management and Substance Use Disorder Treatment (MED207.154) CPT Codes 80156, 80188, 80299, 80305, 80306, 80307, 80320, 80321, 80322, | listed, no stance | Jan 1, 2026 | 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.