86336 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86336

Payer coverage policies that name 86336

86336 appears in 9 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaMaternal Biomarker Screening for Fetal Conditions (0464)covered if criteria are metJul 17, 2026payer document
AetnaNoninvasive Down Syndrome Screening (0282)listed, no stanceApr 17, 2026payer document
AetnaTumor Markers (0352)covered if criteria are metAug 25, 2026payer document
Blue Cross NCPrenatal Testing for Fetal Aneuploidy AHS - G2055listed, no stanceJan 1, 2026payer 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: $15.59 (lab), effective Oct 1, 2026
  • CO: $15.59 (lab_cdl), effective Oct 1, 2025
  • FL: $11.76 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $15.59 (practitioner), effective Apr 1, 2024
  • IN: $13.25 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $11.69 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $15.59 (lab), effective Jan 1, 2026
  • LA: $15.49 (lab_radiology), effective Jul 1, 2012
  • MS: $14.03 (comprehensive), effective Jul 1, 2026
  • ND: $15.59 (physician), effective Aug 1, 2026
  • NE: $15.59 (lab), effective Jul 1, 2026
  • NY: $6.57 (lab), effective Aug 1, 2026
  • OH: $11.69 (lab), effective Apr 1, 2021
  • OK: $13.87 (physician, non-facility), effective Jul 1, 2026
  • TX: $14.50 (hhsc_family_planning_program, Hhsc Family Planning Program), effective Mar 1, 2021
  • VA: $15.59 (medical), effective Jan 1, 2020
  • VT: $15.20 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $12.47 (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.