84591 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 84591

Payer coverage policies that name 84591

84591 appears in 11 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaAutism Spectrum Disorders (0648)not coveredOct 2, 2025payer document
AetnaComplementary and Alternative Medicine (0388)listed, no stanceJun 25, 2026payer document
AetnaNonstandard Laboratory Test Panels (0499)listed, no stanceAug 3, 2026payer document
AetnaPremenstrual Syndrome and Premenstrual Dysphoric Disorder (0512)
Vestibular stimulation, plasma leptin, measurement of serum trace elements, allopregnanolone antagonist, aromatherapy, measurement of serum melatonin levels
not coveredAug 5, 2026payer document
Blue Cross & Blue Shield of MississippiIntracellular Micronutrient Analysisunproven / investigationalpayer document
Blue Cross NCMicronutrient Testing AHS – G2099listed, no stanceApr 1, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 84030-84999)Mar 1, 2024payer document
Blue Shield of California| Intracellular Micronutrient Analysis (2.04.73)listed, no stancepayer document
BlueCross BlueShield of South CarolinaMicronutrient Testing (CAM 270)listed, no stanceApr 1, 2026payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document
Premera Blue CrossIntracellular Micronutrient Analysislisted, no stanceOct 14, 2025payer document

Medicaid fee-for-service

  • AZ: $17.06 (lab), effective Oct 1, 2026
  • CO: $14.21 (lab_cdl), effective Jul 1, 2026
  • IL: $11.94 (practitioner), effective Apr 1, 2024
  • IN: $14.50 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024
  • KS: $10.88 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $17.06 (lab), effective Jan 1, 2026
  • LA: $14.50 (lab_radiology), effective Jul 1, 2025
  • MS: $15.35 (comprehensive), effective Jul 1, 2026
  • ND: $17.06 (physician), effective Aug 1, 2026
  • NE: $17.06 (lab), effective Jul 1, 2026
  • OH: $12.80 (lab), effective Apr 1, 2019
  • OK: $15.17 (physician, non-facility), effective Jul 1, 2026
  • VA: $12.99 (medical), effective Jul 1, 2014
  • VT: $16.63 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $13.65 (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.