Payer policies › CPT 8102581025 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 81025 Payer coverage policies that name 81025 81025 appears in 3 coverage policies from Aetna, Cigna, Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Myalgic Encephalomyelitis - Chronic Fatigue Syndrome (ME/CSF) (0369) covered if criteria are met (range 81000-81099) May 20, 2026 payer document Cigna Infertility Services (0089) not covered Jun 15, 2025 payer document Premera Blue Cross Preventive Care covered if criteria are met Sep 21, 2026 payer document
Medicaid fee-for-service AZ: $8.61 (lab), effective Oct 1, 2026 CO: $7.32 (lab_cdl), effective Apr 1, 2026 FL: $4.65 (lab_independent, non-facility), effective Jan 1, 2026 IL: $6.03 (practitioner), effective Jul 1, 2024 IN: $7.32 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2015 KS: $5.57 (default, Exempt Physician), effective Jul 1, 2023 KY: $8.61 (lab), effective Jan 1, 2026 LA: $6.31 (family_planning_clinic), effective Feb 1, 2013 MS: $7.75 (comprehensive), effective Jul 1, 2026 ND: $8.61 (physician), effective Aug 1, 2026 NE: $8.61 (lab), effective Jul 1, 2026 NY: $2.02 (lab), effective Aug 1, 2026 OH: $6.46 (lab), effective Apr 1, 2019 OK: $7.66 (physician, non-facility), effective Jul 1, 2026 TX: $8.01 (hhsc_family_planning_program, Hhsc Family Planning Program), effective Jul 1, 2018 VA: $7.09 (medical), effective Jul 1, 2014 VT: $8.39 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $6.89 (family_planning, facility), effective Jul 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.