Payer policies › CPT 8509785097 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 85097 Payer coverage policies that name 85097 85097 appears in 2 coverage policies from Aetna, Cigna.
Payer Policy Role in policy Reviewed Document Aetna Hematopoietic Cell Transplantation for Aplastic Anemia and other Bone Marrow Failure Syndromes (0627) listed, no stance Sep 23, 2026 payer document Cigna Laboratory Testing Services (0604) not covered May 15, 2026 payer document
Medicaid fee-for-service AZ: $23.36 (outpatient_hospital, RF133), effective Oct 1, 2025 CO: $38.97 (chp_plus, non-facility), effective Jul 1, 2026 FL: $47.81 (lab_independent, non-facility), effective Jan 1, 2026 IL: $31.05 (practitioner), effective Apr 1, 2024 IN: $37.03 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $47.60 (default, Exempt Physician), effective Jul 1, 2023 KY: $66.01 (lab), effective Jan 1, 2026 LA: $64.35 (lab_radiology), effective Jul 1, 2012 MA: $35.33 (physician_surgery, facility), effective May 1, 2024 MS: $33.94 (comprehensive), effective Jul 1, 2026 ND: $75.10 (physician), effective Aug 1, 2026 NE: $57.50 (physician, facility), effective Jul 1, 2026 NY: $20.42 (lab), effective Aug 1, 2026 OH: $34.88 (lab, facility), effective Apr 1, 2025 OK: $35.57 (physician, facility), effective Jul 1, 2026 TX: $58.38 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Sep 1, 2025 VA: $33.85 (medical, facility), effective Jul 1, 2026 VT: $625.58 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $41.09 (kidneycenters), effective Jul 1, 2026 WY: $356.30 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.