84450 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 84450

Payer coverage policies that name 84450

84450 appears in 11 coverage policies from Aetna, Blue Cross NC, Cigna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaElivaldogene Autotemcel (Skysona) (1017)listed, no stanceApr 8, 2026payer document
AetnaEtranacogene Dezaparvovec-drlb (Hemgenix) (1023)listed, no stanceApr 17, 2026payer document
AetnaFidanacogene Elaparvovec-dzkt (Beqvez) (1060)listed, no stanceApr 20, 2026payer document
AetnaHepatitis A Vaccine (0048)listed, no stanceMar 11, 2026payer document
AetnaIxabepilone (Ixempra) (0869)listed, no stanceApr 7, 2026payer document
AetnaMarnetegragene Autotemcel (Kresladi) (1102)listed, no stanceJul 13, 2026payer document
AetnaValoctocogene Roxaparvovec-rvox (Roctavian) (1037)listed, no stanceApr 20, 2026payer document
Blue Cross NCBiomarkers for Myocardial Infarction and Chronic Heart Failure AHS - G2150listed, no stanceJul 1, 2025payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 84030-84999)Mar 1, 2024payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document
Premera Blue CrossBiomarkers for Myocardial Infarction and Chronic Heart Failurelisted, no stanceOct 14, 2025payer document

Medicaid fee-for-service

  • AZ: $5.18 (lab), effective Oct 1, 2026
  • CO: $5.18 (lab_cdl), effective Oct 1, 2025
  • FL: $2.80 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $5.02 (practitioner), effective Feb 1, 2013
  • IN: $4.40 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $3.88 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $5.18 (lab), effective Jan 1, 2026
  • LA: $5.15 (lab_radiology), effective Jul 1, 2012
  • MS: $4.66 (comprehensive), effective Jul 1, 2026
  • ND: $5.18 (physician), effective Aug 1, 2026
  • NE: $5.18 (lab), effective Jul 1, 2026
  • NY: $5.08 (lab), effective Aug 1, 2026
  • OH: $3.89 (lab), effective Jan 1, 2021
  • OK: $4.61 (physician, non-facility), effective Jul 1, 2026
  • TX: $4.82 (hhsc_family_planning_program, Hhsc Family Planning Program), effective Mar 1, 2021
  • VA: $2.17 (medical), effective Jul 1, 2014
  • VT: $5.05 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $4.14 (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.