84181 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 84181

Payer coverage policies that name 84181

84181 appears in 5 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

PayerPolicyRole in policyReviewedDocument
AetnaLyme Disease and other Tick-Borne Diseases (0215)covered if criteria are metJul 21, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 84030-84999)Mar 1, 2024payer document
BlueCross BlueShield of South CarolinaLaboratory/Pathology Services (CAM 472)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)Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease (MED207.008)
CPT Codes 81291, 81401, 82172, 82397, 82465, 82610, 82652, 82664, 83090,
listed, no stanceJul 15, 2026payer document

Medicaid fee-for-service

  • AZ: $17.03 (lab), effective Oct 1, 2026
  • CO: $13.84 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $9.20 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $23.45 (practitioner), effective Apr 1, 2024
  • IN: $14.11 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $10.86 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $17.03 (lab), effective Jan 1, 2026
  • MA: $13.01 (physician_surgery), effective May 1, 2024
  • MS: $15.33 (comprehensive), effective Jul 1, 2026
  • ND: $17.03 (physician), effective Aug 1, 2026
  • NE: $17.03 (lab), effective Jul 1, 2026
  • OH: $12.77 (lab), effective Apr 1, 2021
  • OK: $15.15 (physician, non-facility), effective Jul 1, 2026
  • VA: $15.34 (medical), effective Jul 1, 2026
  • VT: $16.60 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $13.62 (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.