86316 CPT® code: payer coverage and prior authorization10 of 14 payer prior-auth lists that name 86316 require prior authorization or set conditions: Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Michigan, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Utah, Molina Healthcare of Washington, Molina Healthcare, Inc. (national grid).
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of California | Medicare Advantage | CA | prior auth required | Jul 1, 2021 | Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021 | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 | |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 | |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| Molina Healthcare of New Mexico | Medicare Advantage | NM | prior auth required | Jan 1, 2021 | Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of South Carolina | Medicare Advantage | SC | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 | |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 | |
| Molina Healthcare, Inc. (national grid) | Molina national (MHI) Medicare grid | All | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021 |
86316 appears in 13 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Hypoxic Ischemic Encephalopathy (0812) | not covered | Nov 20, 2025 | payer document |
| Aetna | Nusinersen (Spinraza) (0915) | not covered | Sep 9, 2026 | payer document |
| Aetna | Salivary Tests (0608) | not covered | Sep 23, 2026 | payer document |
| Aetna | Tumor Markers (0352) | covered if criteria are met | Aug 25, 2026 | payer document |
| Aetna | Tumor Markers (0352) | listed, no stance | Aug 25, 2026 | payer document |
| Aetna | Tumor Markers (0352) | not covered | Aug 25, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Urinary Biomarkers For Cancer Screening Diagnosis And Surveillance | unproven / investigational | payer document | |
| Blue Cross Blue Shield of Massachusetts | Tumor Markers (167) | listed, no stance | payer document | |
| Blue Cross NC | Gene Expression Profiling and Protein Biomarkers for Prostate Cancer AHS - M2166 | listed, no stance | Apr 1, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 86000-86999) | Mar 1, 2024 | payer document |
| Blue Cross NC | Serum Tumor Markers for Malignancies AHS - G2124 | listed, no stance | Apr 1, 2026 | payer document |
| Blue Cross NC | Urinary Tumor Markers for Bladder Cancer AHS - G2125 | listed, no stance | Apr 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Serum Tumor Markers for Malignancies (CAM 277) | listed, no stance | Apr 1, 2026 | payer document |
| Cigna | Laboratory Testing Services (0604) | not covered | May 15, 2026 | payer document |
| Premera Blue Cross | Urinary Tumor Markers for Bladder Cancer | listed, no stance | Oct 14, 2025 | 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.