81299 CPT® code: payer coverage and prior authorization25 of 26 payer prior-auth lists that name 81299 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Cigna, Humana, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Michigan, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington, Rocky Mountain Health Plans, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Federal Employee Program (FEP) | AZ | prior auth under conditions | Only for testing unaffected individuals or carrier screening | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Feb 18, 2013 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Feb 18, 2013 | Master Precertification List (For Health Care Providers) |
| Cigna | Laboratory Management | All | prior auth required | Oct 1, 2026 | Cigna Lab Codes (title from file name) | |
| Cigna | Laboratory Management | All | prior auth required | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs | |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community Health Plans (BCCHP), Illinois Medicaid | IL | prior auth required | Carelon-managed | Aug 1, 2025 | Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026 |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) | IL | prior auth required | eviCore-managed | Jan 1, 2025 | Procedure Code List, Effective 1/1/2025 |
| 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 | 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 | LA | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate | |
| Humana | Humana Healthy Horizons | OH | prior auth required | Jan 1, 2027 | 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list | |
| Humana | Humana Healthy Horizons | VA | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) | |
| 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 | ||
| Molina Healthcare of California | Medicare Advantage | CA | prior auth required | Jul 1, 2021 | Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021 | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | vendor review only eviCore in IL/MI/OH/NY/WI | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | vendor review only eviCore in IL/MI/OH/NY/WI | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Contact eviCore for PA | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Jul 1, 2021 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | vendor review only eviCore in IL/MI/OH/NY/WI | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | vendor review only eviCore in IL/MI/OH/NY/WI | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 |
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth required | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 | |
| 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 |
81299 appears in 14 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Colonoscopy, Colorectal Cancer Screening, and Related Procedures (0516) | listed, no stance (range 81298-81300) | Aug 20, 2026 | payer document |
| Aetna | Genetic Testing (0140) Genetic testing for dominant polycystic kidney disease (PKD1 and PKD2) | covered if criteria are met (range 81298-81300) | Aug 18, 2026 | payer document |
| Aetna | Polymerase Chain Reaction Testing: Selected Indications (0650) | covered if criteria are met (range 81298-81300) | Sep 10, 2026 | payer document |
| Aetna | Tumor Markers (0352) | covered if criteria are met (range 81298-81300) | Aug 25, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Genetic Testing (L.2.04.409) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Genetic Testing For Lynch Syndrome And Other Inherited Colon Cancer Syndromes | covered if criteria are met (range 81298-81300) | payer document | |
| Blue Cross & Blue Shield of Mississippi | Germline Genetic Testing For Pancreatic Cancer Susceptibility Genes Atm Brca1 Brca2 Cdkn2a Epcam Mlh1 Msh2 Msh6 Palb2 Pms2 Stk11 And Tp53 (A.2.04.148) | unproven / investigational | payer document | |
| Blue Cross NC | Genetic Testing for Neurofibromatosis and Related Disorders AHS – M2134 | listed, no stance | Jul 1, 2025 | payer document |
| Blue Cross NC | Lynch Syndrome AHS - M2004 | listed, no stance | Nov 1, 2025 | payer document |
| Blue Shield of California | Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes (2.04.08) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Genetic Testing for Neurofibromatosis and Related Disorders (CAM 292) | listed, no stance | Jul 1, 2026 | payer document |
| Regence | Evaluating the Utility of Genetic Panels (Genetic Testing 64) | listed, no stance | Jun 1, 2026 | payer document |
| Regence | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes (Genetic Testing 06) | listed, no stance | Dec 1, 2025 | payer document |
| Regence | Genetic and Molecular Diagnostic Testing (Genetic Testing 20) | listed, no stance (range 81290-81300) | Apr 1, 2025 | payer document |
Prior authorization required or conditional in CO, IN, LA, MS, ND, VA, WA, WV, WY.
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.