86001 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 86001 require prior authorization or set conditions: Rocky Mountain Health Plans.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth required | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 |
86001 appears in 19 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, BlueCross BlueShield of South Carolina, Centene, Cigna, Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Allergy and Hypersensitivity (0038) | not covered | Mar 10, 2026 | payer document |
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) EEG theta/beta power ratio, Gut microbiota profile, polygenic risk score, evaluation of kynurenine pathway | not covered | Jul 7, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | not covered | Oct 2, 2025 | payer document |
| Aetna | Nonstandard Laboratory Test Panels (0499) | listed, no stance | Aug 3, 2026 | payer document |
| Anthem | Selected Blood, Serum and Cellular Allergy and Toxicity Tests (LAB.00027) | unproven / investigational | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Allergy Tests Of Uncertain Efficacy (L.2.01.429) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Allergy Testing sad | not covered | Mar 18, 2026 | payer document |
| Blue Cross NC | Allergen Testing AHS – G2031 | listed, no stance | Apr 1, 2026 | payer document |
| Blue Cross NC | Diagnosis of Idiopathic Environmental Intolerance AHS - G2056 | listed, no stance | Jan 1, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 86000-86999) | Mar 1, 2024 | payer document |
| BlueCross BlueShield of South Carolina | Allergen Testing (CAM 051) | listed, no stance | Apr 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Diagnosis and Management of Idiopathic Environmental Intolerance (i.e., Clinical Ecology) (CAM 267) Code Number | listed, no stance | Jan 1, 2026 | payer document |
| Centene | Allergy Testing and Therapy (CP.MP.100) | covered if criteria are met | Sep 1, 2023 | payer document |
| Centene | Allergy Testing and Therapy (CP.MP.100) | not covered | Sep 1, 2023 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.BH.124) | not covered | Mar 1, 2024 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.MP.124) | not covered | Feb 1, 2022 | payer document |
| Cigna | Laboratory Testing Services (0604) | not covered | May 15, 2026 | payer document |
| Premera Blue Cross | Allergen Testing | listed, no stance | Feb 6, 2026 | payer document |
| Premera Blue Cross | Diagnosis of Idiopathic Environmental Intolerance | listed, no stance | Feb 6, 2026 | payer document |
| Regence | Allergy and Sensitivity Tests of Uncertain Efficacy (Laboratory 01) | listed, no stance | Jun 1, 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.