84484 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 84484

Payer coverage policies that name 84484

84484 appears in 11 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaCardiovascular Disease Risk Tests (0381)not coveredAug 25, 2026payer document
AetnaHeart Transplantation (0586)not coveredSep 11, 2026payer document
AetnaOnasemnogene Abeparvovec (Zolgensma and Itvisma) (0953)listed, no stanceAug 10, 2026payer document
Blue Cross NCBiomarkers for Myocardial Infarction and Chronic Heart Failure AHS - G2150listed, no stanceJul 1, 2025payer document
Blue Cross NCCardiovascular Disease Risk Assessment AHS – G2050listed, no stanceApr 1, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 84030-84999)Mar 1, 2024payer document
Blue Cross NCSerum Tumor Markers for Malignancies AHS - G2124listed, no stanceApr 1, 2026payer document
BlueCross BlueShield of South CarolinaCardiovascular Disease Risk Assessment (CAM 188)listed, no stanceApr 1, 2026payer document
BlueCross BlueShield of South CarolinaSerum Tumor Markers for Malignancies (CAM 277)listed, no stanceApr 1, 2026payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document
Premera Blue CrossSerum Tumor Markers for Malignancieslisted, no stanceOct 1, 2026payer document

Medicaid fee-for-service

  • AZ: $12.47 (lab), effective Oct 1, 2026
  • CO: $10.39 (lab_cdl), effective Jul 1, 2026
  • FL: $6.73 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $8.49 (practitioner), effective Apr 1, 2025
  • IN: $10.60 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2018
  • KS: $9.35 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $12.47 (lab), effective Jan 1, 2026
  • LA: $10.76 (lab_radiology), effective Jul 1, 2012
  • MS: $11.22 (comprehensive), effective Jul 1, 2026
  • ND: $12.47 (physician), effective Aug 1, 2026
  • NE: $12.47 (lab), effective Jul 1, 2026
  • NY: $8.13 (lab), effective Aug 1, 2026
  • OH: $9.35 (lab), effective Apr 1, 2019
  • OK: $11.09 (physician, non-facility), effective Jul 1, 2026
  • VA: $11.37 (medical), effective Jul 1, 2014
  • VT: $12.16 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $9.98 (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.