84703 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 84703

Payer coverage policies that name 84703

84703 appears in 9 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Centene, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaHuman Chorionic Gonadotropin (hCG) (1081)listed, no stanceOct 8, 2026payer document
AetnaInfertility (0327)covered if criteria are metJul 16, 2026payer document
AetnaMaternal Biomarker Screening for Fetal Conditions (0464)covered if criteria are metJul 17, 2026payer document
Blue Cross NCPrenatal Screening (Nongenetic) AHS - G2035listed, no stanceOct 1, 2025payer document
Blue Cross NCPrenatal Testing for Fetal Aneuploidy AHS - G2055listed, no stanceJan 1, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 84030-84999)Mar 1, 2024payer document
BlueCross BlueShield of South CarolinaPrenatal Screening (Nongenetics) (CAM 119)
Number		listed, no stanceJul 1, 2026payer document
Centenecovered if criteria are metJan 1, 2026payer document
Premera Blue CrossSerum Tumor Markers for Malignancieslisted, no stanceOct 1, 2026payer document

Medicaid fee-for-service

  • AZ: $7.52 (lab), effective Oct 1, 2026
  • CO: $7.52 (lab_cdl), effective Oct 1, 2025
  • FL: $4.06 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $7.16 (practitioner), effective Jan 1, 2012
  • IN: $6.39 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $5.64 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $7.52 (lab), effective Jan 1, 2026
  • LA: $7.47 (lab_radiology), effective Jul 1, 2012
  • MS: $6.77 (comprehensive), effective Jul 1, 2026
  • ND: $7.52 (physician), effective Aug 1, 2026
  • NE: $7.52 (lab), effective Jul 1, 2026
  • NY: $2.02 (lab), effective Aug 1, 2026
  • OH: $5.64 (lab), effective Jan 1, 2021
  • OK: $6.69 (physician, non-facility), effective Jul 1, 2026
  • TX: $6.99 (hhsc_family_planning_program, Hhsc Family Planning Program), effective Mar 1, 2021
  • VA: $3.22 (medical), effective Jul 1, 2014
  • VT: $7.33 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $6.02 (family_planning, 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.