86301 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86301

0 of 1 payer prior-auth lists that name 86301 require prior authorization or set conditions.

Payer coverage policies that name 86301

86301 appears in 9 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaTumor Markers (0352)covered if criteria are metAug 25, 2026payer document
AnthemCancer Antigen 19-9 Testing (CG-LAB-35)covered if criteria are metAug 13, 2026payer document
Blue Cross & Blue Shield of Rhode IslandSerum Tumor Markers for Breast and Gastrointestinal Malignanciescovered if criteria are metJun 3, 2026payer document
Blue Cross & Blue Shield of Rhode IslandSerum Tumor Markers for Breast and Gastrointestinal Malignancies
Medicare Advantage Plans		listed, no stanceJun 3, 2026payer document
Blue Cross Blue Shield of MassachusettsSerum Tumor Markers (538)covered if criteria are metpayer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 86000-86999)Mar 1, 2024payer document
Blue Cross NCSerum Tumor Markers for Malignancies AHS - G2124listed, no stanceApr 1, 2026payer document
BlueCross BlueShield of South CarolinaSerum Tumor Markers for Malignancies (CAM 277)listed, no stanceApr 1, 2026payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document
Premera Blue CrossSerum Tumor Markers for Malignancieslisted, no stanceOct 1, 2026payer document

Medicaid fee-for-service

  • AZ: $20.81 (lab), effective Oct 1, 2026
  • CO: $20.81 (lab_cdl), effective Oct 1, 2025
  • FL: $11.24 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $20.81 (practitioner), effective Apr 1, 2024
  • IN: $17.69 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $15.61 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $20.81 (lab), effective Jan 1, 2026
  • LA: $20.81 (lab_radiology), effective Jan 1, 2020
  • MS: $18.73 (comprehensive), effective Jul 1, 2026
  • ND: $20.81 (physician), effective Aug 1, 2026
  • NE: $20.81 (lab), effective Jul 1, 2026
  • NY: $20.81 (lab), effective Aug 1, 2026
  • OH: $15.61 (lab), effective Apr 1, 2021
  • OK: $18.51 (physician, non-facility), effective Jul 1, 2026
  • VA: $9.45 (medical), effective Jan 1, 2016
  • VT: $20.29 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $16.65 (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.