86611 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86611

Payer coverage policies that name 86611

86611 appears in 2 coverage policies from Blue Cross NC, Cigna.

PayerPolicyRole in policyReviewedDocument
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 86000-86999)Mar 1, 2024payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document

Medicaid fee-for-service

  • AZ: $10.18 (lab), effective Oct 1, 2026
  • CO: $10.18 (lab_cdl), effective Oct 1, 2025
  • FL: $5.50 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $10.18 (practitioner), effective Apr 1, 2024
  • IN: $8.65 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $6.88 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $10.18 (lab), effective Jan 1, 2026
  • LA: $10.18 (lab_radiology), effective Jan 1, 2020
  • MS: $9.16 (comprehensive), effective Jul 1, 2026
  • ND: $10.18 (physician), effective Aug 1, 2026
  • NE: $10.18 (lab), effective Jul 1, 2026
  • NY: $8.11 (lab), effective Aug 1, 2026
  • OH: $7.63 (lab), effective Apr 1, 2021
  • OK: $9.05 (physician, non-facility), effective Jul 1, 2026
  • VA: $9.45 (medical), effective Jul 1, 2014
  • VT: $9.93 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $8.14 (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.