84105 CPT® code: payer coverage and prior authorization84105 appears in 9 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Autism Spectrum Disorders (0648) | not covered | Oct 2, 2025 | payer document |
| Aetna | Kidney Stones: Selected Interventions (0392) | listed, no stance | Jun 23, 2026 | payer document |
| Aetna | Premenstrual Syndrome and Premenstrual Dysphoric Disorder (0512) Vestibular stimulation, plasma leptin, measurement of serum trace elements, allopregnanolone antagonist, aromatherapy, measurement of serum melatonin levels | not covered | Aug 5, 2026 | payer document |
| Blue Cross NC | Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing AHS - G2164 | listed, no stance | Apr 1, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 84030-84999) | Mar 1, 2024 | payer document |
| BlueCross BlueShield of South Carolina | Parathyroid Hormone, Phosphorus, Calcium and Magnesium Testing (CAM 217) | listed, no stance | Apr 1, 2026 | payer document |
| Cigna | Laboratory Testing Services (0604) | not covered | May 15, 2026 | payer document |
| Premera Blue Cross | Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing | listed, no stance | Oct 14, 2025 | payer document |
| Regence | Screening Laboratory Testing (Laboratory 80) | listed, no stance | Dec 1, 2025 | payer document |
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.