86777 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86777

Payer coverage policies that name 86777

86777 appears in 3 coverage policies from Aetna, Blue Cross NC, Cigna.

PayerPolicyRole in policyReviewedDocument
AetnaAlzheimer's Disease Tests (0349)not coveredAug 4, 2026payer document
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: $14.39 (lab), effective Oct 1, 2026
  • CO: $11.99 (lab_cdl), effective Jul 1, 2026
  • FL: $7.77 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $12.36 (practitioner), effective Mar 1, 2013
  • IN: $12.23 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $9.17 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $14.39 (lab), effective Jan 1, 2026
  • LA: $14.33 (lab_radiology), effective Jul 1, 2012
  • MS: $12.95 (comprehensive), effective Jul 1, 2026
  • ND: $14.39 (physician), effective Aug 1, 2026
  • NE: $14.39 (lab), effective Jul 1, 2026
  • NY: $14.39 (lab), effective Aug 1, 2026
  • OH: $10.79 (lab), effective Apr 1, 2021
  • OK: $12.80 (physician, non-facility), effective Jul 1, 2026
  • TX: $13.38 (hhsc_family_planning_program, Hhsc Family Planning Program), effective Mar 1, 2021
  • VA: $1.72 (medical), effective Jul 1, 2014
  • VT: $14.03 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $11.51 (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.