Payer policies › CPT 8449084490 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 84490 Payer coverage policies that name 84490 84490 appears in 3 coverage policies from Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Cigna.
Payer Policy Role in policy Reviewed Document Blue Cross & Blue Shield of Mississippi Fecal Analysis In The Diagnosis Of Intestinal Dysbiosis unproven / investigational 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: $9.93 (lab), effective Oct 1, 2026 CO: $9.93 (lab_cdl), effective Oct 1, 2025 FL: $5.36 (lab_independent, non-facility), effective Jan 1, 2026 IL: $6.95 (practitioner), effective Apr 1, 2024 IN: $8.44 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024 KS: $7.65 (default, Exempt Physician), effective Jul 1, 1987 KY: $9.93 (lab), effective Jan 1, 2026 LA: $8.44 (lab_radiology), effective Jul 1, 2025 MS: $8.94 (comprehensive), effective Jul 1, 2026 ND: $9.93 (physician), effective Aug 1, 2026 NE: $9.93 (lab), effective Jul 1, 2026 OH: $7.45 (lab), effective Apr 1, 2019 OK: $8.83 (physician, non-facility), effective Jul 1, 2026 VA: $2.17 (medical), effective Jul 1, 2014 VT: $9.68 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $7.94 (physician, facility), 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.