85547 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 85547 require prior authorization or set conditions: UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth required | Jan 1, 2015 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
85547 appears in 4 coverage policies from Aetna, Blue Cross NC, Capital Blue Cross, Cigna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Obsolete and Unreliable Tests and Procedures (0438) Lupus erythematosus (LE) cell test or the LE Cell Phenomenon test - no specific code . | not covered | Jul 16, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 85520-85999) | Mar 1, 2024 | payer document |
| Capital Blue Cross | Experimental and Investigational Procedures (MP 4.002) Procedure codes: Lab services | listed, no stance | Sep 1, 2026 | payer document |
| Cigna | Laboratory Testing Services (0604) | not covered | May 15, 2026 | payer document |
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.