86806 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86806

Payer coverage policies that name 86806

86806 appears in 20 coverage policies from Blue Cross NC, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

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
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (SUR703.032)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceMay 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (SUR703.043)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceSep 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (SUR703.037)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceAug 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Autoimmune Diseases (SUR703.036)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Breast Cancer (SUR703.038)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceMay 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma (SUR703.039)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceSep 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) (SUR703.029)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceMay 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (SUR703.041)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (SUR703.034)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceMay 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias (SUR703.033)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Hodgkin Lymphoma (SUR703.040)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceApr 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (SUR703.035)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceAug 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (SUR703.031)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceMay 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (SUR703.030)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceMay 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Primary Systemic Amyloidosis (SUR703.046)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212,
listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Solid Tumors of Childhood (SUR703.044)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceJun 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia (SUR703.050)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceJan 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors (SUR703.045)
CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211,
listed, no stanceJun 15, 2026payer document

Medicaid fee-for-service

  • AZ: $47.59 (lab), effective Oct 1, 2026
  • CO: $47.59 (lab_cdl), effective Oct 1, 2025
  • FL: $32.47 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $43.45 (practitioner), effective Jul 1, 2026
  • IN: $40.45 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $35.69 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $47.59 (lab), effective Jan 1, 2026
  • LA: $47.37 (lab_radiology), effective Jul 1, 2012
  • MS: $42.83 (comprehensive), effective Jul 1, 2026
  • ND: $47.59 (physician), effective Aug 1, 2026
  • NE: $47.59 (lab), effective Jul 1, 2026
  • OH: $35.69 (lab), effective Apr 1, 2021
  • OK: $42.33 (physician, non-facility), effective Jul 1, 2026
  • VA: $47.59 (medical), effective Jan 1, 2020
  • VT: $46.40 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $38.07 (physician, facility), 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.