Payer policies › CPT 8120081200 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 81200 18 of 18 payer prior-auth lists that name 81200 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Cigna, Humana, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source Cigna Laboratory Management All prior auth under conditions Review when billed in a panel with a PA-required code Oct 1, 2026 Cigna Lab Codes (title from file name) Blue Cross and Blue Shield of Texas Texas PA exemption (gold card), outpatient, fully insured TX prior auth required Gold-card exemption available Jul 1, 2026 BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana Healthy Horizons IL prior auth required Jan 1, 2027 Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies . Humana Humana Healthy Horizons IN prior auth required Jan 1, 2027 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a Humana Humana Healthy Horizons KY prior auth required Jan 1, 2027 please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management UnitedHealthcare Community Plan Indiana Hoosier Care Connect IN prior auth required Oct 1, 2026 Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026 UnitedHealthcare Community Plan Indiana PathWays for Aging (MLTSS) IN prior auth required Oct 1, 2026 Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026
Payer coverage policies that name 81200 81200 appears in 9 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, Regence, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Genetic Testing (0140)Genetic testing for dominant polycystic kidney disease (PKD1 and PKD2) covered if criteria are met Aug 18, 2026 payer document Blue Cross & Blue Shield of Mississippi Genetic Testing (L.2.04.409) covered if criteria are met payer document Blue Cross NC Prenatal Screening (Genetic) AHS - M2179 listed, no stance Oct 1, 2025 payer document Blue Shield of California General Approach to Evaluating the Utility of Genetic Panels (2.04.92) listed, no stance payer document Blue Shield of California | Preimplantation Genetic Testing (4.02.05) listed, no stance payer document Regence Evaluating the Utility of Genetic Panels (Genetic Testing 64) listed, no stance Jun 1, 2026 payer document Regence Genetic and Molecular Diagnostic Testing (Genetic Testing 20) listed, no stance (range 81200-81257) Apr 1, 2025 payer document Regence Reproductive Carrier Screening for Genetic Diseases (Genetic Testing 81) listed, no stance Oct 1, 2025 payer document UnitedHealthcare Molecular Pathology/Molecular Diagnostics/ Genetic Testing (MMP210.36)Non-Covered listed, no stance Sep 1, 2026 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Medicaid fee-for-service Prior authorization required or conditional in CO, IN, MS, ND.
AZ: $47.25 (lab), effective Oct 1, 2026 CO: $40.16 (lab_cdl), effective Apr 1, 2026 FL: $25.52 (lab_independent, non-facility), effective Jan 1, 2026 IL: $33.08 (practitioner), effective Apr 1, 2024 IN: $40.16 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 15, 2018 KS: $144.82 (default, Exempt Physician), effective Jan 1, 2013 KY: $47.25 (lab), effective Jan 1, 2026 MS: $42.53 (comprehensive), effective Jul 1, 2026 ND: $47.25 (physician), effective Aug 1, 2026 NE: $47.25 (lab), effective Jul 1, 2026 OH: $35.44 (lab), effective Apr 1, 2019 OK: $42.03 (physician, non-facility), effective Jul 1, 2026 VA: $47.25 (medical), effective Jan 1, 2018 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $37.80 (physician, facility), effective Jul 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.