81209 CPT® code: payer coverage and prior authorization5 of 5 payer prior-auth lists that name 81209 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Cigna, Humana.
| 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) |
| 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 | Oak Street Health | All | prior auth required | Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management |
81209 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Breast and Ovarian Cancer Susceptibility Gene Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy (0227) | listed, no stance | Apr 14, 2026 | payer 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 |
| 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 |
Prior authorization required or conditional in CO, MS, ND, VT, WA, WV.
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.