Payer policies › CPT 8539685396 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 85396 Payer coverage policies that name 85396 85396 appears in 2 coverage policies from Blue Cross NC, Cigna.
Payer Policy Role in policy Reviewed Document Blue Cross NC Professional Pathology Billing Requirements AHS – R2169 listed, no stance (range 85300-85397) Mar 1, 2024 payer document Cigna Laboratory Testing Services (0604) not covered May 15, 2026 payer document
Medicaid fee-for-service AZ: $19.53 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $19.07 (chp_plus, non-facility), effective Jul 1, 2026 FL: $11.79 (lab_independent, non-facility), effective Jan 1, 2026 IL: $12.88 (practitioner), effective Apr 1, 2024 IN: $15.00 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $11.62 (default, Exempt Physician), effective Jul 1, 2023 MA: $14.28 (physician_surgery), effective May 1, 2024 MS: $13.60 (comprehensive), effective Jul 1, 2026 ND: $17.27 (physician), effective Aug 1, 2026 NE: $37.54 (physician, non-facility), effective Jul 1, 2026 OH: $11.58 (lab), effective Apr 1, 2026 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $15.24 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Sep 1, 2021 VA: $12.50 (medical), effective Jul 1, 2005 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $9.17 (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.