Payer policies › CPT 8412684126 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 84126 Payer coverage policies that name 84126 84126 appears in 3 coverage policies from Aetna, Blue Cross NC, Cigna.
Payer Policy Role in policy Reviewed Document Aetna Givosiran (Givlaari) (0961) listed, no stance Jan 9, 2026 payer document Blue Cross NC Professional Pathology Billing Requirements AHS – R2169 listed, no stance (range 84030-84999) Mar 1, 2024 payer document Cigna Laboratory Testing Services (0604) not covered May 15, 2026 payer document
Medicaid fee-for-service AZ: $39.11 (lab), effective Oct 1, 2026 CO: $39.11 (lab_cdl), effective Oct 1, 2025 FL: $21.12 (lab_independent, non-facility), effective Jan 1, 2026 IL: $27.38 (practitioner), effective Apr 1, 2024 IN: $33.24 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024 KS: $7.88 (default, Exempt Physician), effective Jul 1, 1987 KY: $39.11 (lab), effective Jan 1, 2026 LA: $33.24 (lab_radiology), effective Jul 1, 2025 MS: $35.20 (comprehensive), effective Jul 1, 2026 ND: $39.11 (physician), effective Aug 1, 2026 NE: $39.11 (lab), effective Jul 1, 2026 OH: $29.33 (lab), effective Apr 1, 2019 OK: $34.79 (physician, non-facility), effective Jul 1, 2026 VA: $4.18 (medical), effective Jul 1, 2014 VT: $38.13 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $31.29 (kidneycenters), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 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.