Payer policies › CPT 8554085540 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 85540 Payer coverage policies that name 85540 85540 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 85520-85999) Mar 1, 2024 payer document Cigna Laboratory Testing Services (0604) not covered May 15, 2026 payer document
Medicaid fee-for-service AZ: $8.60 (lab), effective Oct 1, 2026 CO: $8.60 (lab_cdl), effective Oct 1, 2025 FL: $4.64 (lab_independent, non-facility), effective Jan 1, 2026 IL: $6.02 (practitioner), effective Apr 1, 2024 IN: $7.31 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020 KS: $6.45 (default, Exempt Physician), effective Jul 1, 2023 KY: $8.60 (lab), effective Jan 1, 2026 LA: $8.56 (lab_radiology), effective Jul 1, 2012 MS: $7.74 (comprehensive), effective Jul 1, 2026 ND: $8.60 (physician), effective Aug 1, 2026 NE: $8.60 (lab), effective Jul 1, 2026 NY: $8.60 (lab), effective Aug 1, 2026 OH: $6.45 (lab), effective Apr 1, 2021 OK: $7.65 (physician, non-facility), effective Jul 1, 2026 VA: $5.00 (medical), effective Jul 1, 2014 VT: $8.39 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $6.88 (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.