81376 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 81376

20 of 20 payer prior-auth lists that name 81376 require prior authorization or set conditions: CarePlus Health Plans, Cigna, Humana.

PayerPlanStatePrior authConditionsSinceSource
CignaLaboratory ManagementAllprior auth under conditionsReview when billed in a panel with a PA-required codeOct 1, 2026Cigna Lab Codes (title from file name)
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana D-SNP (FL)FLprior auth requiredJan 1, 20271 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
HumanaHumana D-SNP (IL)ILprior auth requiredJan 1, 2027Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
HumanaHumana D-SNP (IN)INprior auth requiredJan 1, 2027*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
HumanaHumana D-SNP (MI)MIprior auth requiredJan 1, 20271 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
HumanaHumana D-SNP (SC)SCprior auth requiredJan 1, 2027Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
HumanaHumana D-SNP (VA)VAprior auth requiredJan 1, 2027Virginia Prior Authorization and Notification List
HumanaHumana Healthy HorizonsFLprior auth requiredJan 1, 20271102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List
HumanaHumana Healthy HorizonsILprior auth requiredJan 1, 2027Humana 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 .
HumanaHumana Healthy HorizonsKYprior auth requiredJan 1, 2027please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
HumanaHumana Healthy HorizonsLAprior auth requiredJan 1, 2027Humana 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
HumanaHumana Healthy HorizonsOHprior auth requiredJan 1, 2027555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list
HumanaHumana Healthy HorizonsOKprior auth requiredJan 1, 2027Humana Healthy Horizons® in Oklahoma Prior Authorization Notification List (PAL) The following preauthorization and notification list
HumanaHumana Healthy HorizonsSCprior auth requiredJan 1, 2027Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical
HumanaHumana Healthy HorizonsVAprior auth requiredJan 1, 2027Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana Puerto Rico MA and Dual Medicare-MedicaidPRprior auth requiredNov 3, 2025Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
HumanaHumana Puerto Rico MA and Dual Medicare-MedicaidPRprior auth requiredNov 3, 2025Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification

Payer coverage policies that name 81376

81376 appears in 30 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence.

PayerPolicyRole in policyReviewedDocument
AetnaCeliac Disease Laboratory Testing (0561)not coveredAug 3, 2026payer document
AetnaComplex Regional Pain Syndrome (CRPS): Diagnosis (0147)not covered (range 81370-81377)Mar 30, 2026payer document
AetnaElivaldogene Autotemcel (Skysona) (1017)listed, no stance (range 81370-81383)Apr 8, 2026payer document
AetnaExagamglogene Autotemcel (Casgevy) (1052)listed, no stance (range 81370-81383)Dec 31, 2025payer document
AetnaLiver Transplantation (0596)listed, no stance (range 81370-81383)Sep 8, 2026payer document
AetnaLovotibeglogene Autotemcel (Lyfgenia) (1053)listed, no stance (range 81370-81383)Dec 31, 2025payer document
AetnaPolymerase Chain Reaction Testing: Selected Indications (0650)covered if criteria are met (range 81370-81377)Sep 10, 2026payer document
Blue Cross & Blue Shield of Rhode IslandHuman Leukocyte Antigen (HLA) Testing Mandate
Medicare Advantage Plans and Commercial Products		listed, no stanceJun 1, 2025payer document
Blue Cross NCGeneral Genetic Testing, Somatic Disorders AHS - M2146listed, no stanceJan 1, 2026payer document
BlueCross BlueShield of South CarolinaGeneral Genetic Testing, Somatic Disorders (CAM 167)
81375 | HLA Class II typing, low resolution (e.g., antigen equivalents; HLA-DRB1/3/4/5 and -DQB1		listed, no stanceJan 1, 2026payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (SUR703.032)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceMay 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (SUR703.043)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceSep 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (SUR703.037)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceAug 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Autoimmune Diseases (SUR703.036)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Breast Cancer (SUR703.038)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceMay 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma (SUR703.039)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceSep 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) (SUR703.029)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceMay 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (SUR703.041)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (SUR703.034)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceMay 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias (SUR703.033)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Hodgkin Lymphoma (SUR703.040)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceApr 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (SUR703.035)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceAug 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (SUR703.031)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceMay 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (SUR703.030)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceMay 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Primary Systemic Amyloidosis (SUR703.046)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,		listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Solid Tumors of Childhood (SUR703.044)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia (SUR703.050)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceJan 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors (SUR703.045)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,		listed, no stanceJun 15, 2026payer document
RegenceGenetic and Molecular Diagnostic Testing (Genetic Testing 20)listed, no stance (range 81370-81408)Apr 1, 2025payer document

Recent prior-auth changes

  • Jan 1, 2027: PA added, Humana

Medicaid fee-for-service

Prior authorization required or conditional in MS, VT, WV, WY.

  • AZ: $122.22 (lab), effective Oct 1, 2026
  • CO: $122.22 (lab_cdl), effective Oct 1, 2025
  • FL: $39.86 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $85.55 (practitioner), effective Apr 1, 2024
  • IN: $103.89 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2024
  • KS: $106.30 (default, Exempt Physician), effective Apr 1, 2014
  • KY: $122.22 (lab), effective Jan 1, 2026
  • MS: $110.00 (comprehensive), effective Jul 1, 2026
  • ND: $122.22 (physician), effective Aug 1, 2026
  • NE: $122.22 (lab), effective Jul 1, 2026
  • OH: $91.67 (lab), effective Apr 1, 2021
  • OK: $108.71 (physician, non-facility), effective Jul 1, 2026
  • VA: $122.22 (medical), effective Jan 1, 2022
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $97.78 (physician, facility), effective Jul 1, 2026
  • WY: $110.00 (professional), effective Apr 1, 2025

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.