86757 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86757

Payer coverage policies that name 86757

86757 appears in 6 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaLyme Disease and other Tick-Borne Diseases (0215)
Testing for other tick-borne diseases from other organisms
not coveredJul 21, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 86000-86999)Mar 1, 2024payer document
Blue Cross NCTesting for Vector-Borne Infections AHS – G2158listed, no stanceOct 1, 2025payer document
BlueCross BlueShield of South CarolinaTesting for Vector-Borne Infections (CAM 210)listed, no stanceOct 1, 2025payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document
Premera Blue CrossTesting for Vector-Borne Infectionslisted, no stanceFeb 6, 2026payer document

Medicaid fee-for-service

  • AZ: $19.35 (lab), effective Oct 1, 2026
  • CO: $16.45 (lab_cdl), effective Apr 1, 2026
  • FL: $10.45 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $19.35 (practitioner), effective Apr 1, 2024
  • IN: $16.45 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $14.51 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $19.35 (lab), effective Jan 1, 2026
  • LA: $19.35 (lab_radiology), effective Jan 1, 2020
  • MS: $17.42 (comprehensive), effective Jul 1, 2026
  • ND: $19.35 (physician), effective Aug 1, 2026
  • NE: $19.35 (lab), effective Jul 1, 2026
  • NY: $19.35 (lab), effective Aug 1, 2026
  • OH: $14.51 (lab), effective Apr 1, 2021
  • OK: $17.21 (physician, non-facility), effective Jul 1, 2026
  • VA: $19.35 (medical), effective Jan 1, 2020
  • VT: $18.87 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $15.48 (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.