85652 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 85652

Payer coverage policies that name 85652

85652 appears in 17 coverage policies from Aetna, Blue Cross NC, Cigna, Premera Blue Cross, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaAbatacept (Orencia) (0720)listed, no stanceJul 1, 2026payer document
AetnaAdalimumab (0655)listed, no stanceJul 13, 2026payer document
AetnaCertolizumab Pegol (Cimzia) (0761)listed, no stanceJul 1, 2026payer document
AetnaEtanercept (0315)
CD11c expression and DNA methylation as biomarkers of etanercept response		listed, no stanceJul 8, 2026payer document
AetnaGolimumab (Simponi and Simponi Aria) (0790)listed, no stanceJul 31, 2026payer document
AetnaGout (0810)covered if criteria are metMar 27, 2026payer document
AetnaInfliximab (0341)listed, no stanceOct 5, 2026payer document
AetnaMyalgic Encephalomyelitis - Chronic Fatigue Syndrome (ME/CSF) (0369)covered if criteria are metMay 20, 2026payer document
AetnaParenteral Immunoglobulins (0206)listed, no stanceOct 8, 2026payer document
AetnaRituximab (0314)listed, no stanceSep 15, 2026payer document
AetnaSmell and Taste Disorders: Diagnosis (0390)covered if criteria are met (range 85651-85652)May 26, 2026payer document
AetnaTocilizumab (0799)listed, no stanceJun 30, 2026payer document
Blue Cross NCGeneral Inflammation Testing AHS - G2155listed, no stanceJul 1, 2025payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 85520-85999)Mar 1, 2024payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document
Premera Blue CrossGeneral Inflammation Testinglisted, no stanceOct 14, 2025payer document
RegenceScreening Laboratory Testing (Laboratory 80)listed, no stanceDec 1, 2025payer document

Medicaid fee-for-service

  • AZ: $2.70 (lab), effective Oct 1, 2026
  • CO: $2.70 (lab_cdl), effective Oct 1, 2025
  • FL: $1.46 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $2.62 (podiatrist), effective Apr 1, 2024
  • IN: $2.29 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $2.03 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $2.70 (lab), effective Jan 1, 2026
  • LA: $2.68 (lab_radiology), effective Jul 1, 2012
  • MS: $2.43 (comprehensive), effective Jul 1, 2026
  • ND: $2.70 (physician), effective Aug 1, 2026
  • NE: $2.70 (lab), effective Jul 1, 2026
  • NY: $2.02 (lab), effective Aug 1, 2026
  • OH: $2.02 (lab), effective Apr 1, 2021
  • OK: $2.40 (physician, non-facility), effective Jul 1, 2026
  • VA: $2.70 (medical), effective Jan 1, 2020
  • VT: $2.63 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $2.16 (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.