Payer policies › CPT 8454084540 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 84540 Payer coverage policies that name 84540 84540 appears in 5 coverage policies from Aetna, Blue Cross NC, Cigna.
Payer Policy Role in policy Reviewed Document Aetna Intermittent Intravenous Insulin Therapy (0742) not covered Nov 26, 2025 payer document Aetna Kidney Stones: Selected Interventions (0392) listed, no stance Jun 23, 2026 payer document Aetna Nonstandard Laboratory Test Panels (0499) listed, no stance Aug 3, 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: $5.56 (lab), effective Oct 1, 2026 CO: $4.63 (lab_cdl), effective Jul 1, 2026 FL: $3.01 (lab_independent, non-facility), effective Jan 1, 2026 IL: $7.78 (practitioner), effective Apr 1, 2024 IN: $4.73 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024 KS: $4.17 (default, Exempt Physician), effective Jul 1, 2023 KY: $5.56 (lab), effective Jan 1, 2026 LA: $4.73 (lab_radiology), effective Jul 1, 2025 MS: $5.00 (comprehensive), effective Jul 1, 2026 ND: $5.56 (physician), effective Aug 1, 2026 NE: $5.56 (lab), effective Jul 1, 2026 NY: $5.08 (lab), effective Aug 1, 2026 OH: $4.17 (lab), effective Apr 1, 2021 OK: $4.95 (physician, non-facility), effective Jul 1, 2026 VA: $4.39 (medical), effective Jul 1, 2014 VT: $5.42 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $4.45 (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.