`86891` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86891

Payer coverage policies that name 86891

86891 appears in 3 coverage policies from Aetna, Blue Cross NC, Cigna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Autotransfusers and Red Blood Cell Genotyping (0639)	covered if criteria are met	Sep 9, 2026	payer document
Blue Cross NC	Professional Pathology Billing Requirements AHS – R2169	listed, no stance (range 86000-86999)	Mar 1, 2024	payer document
Cigna	Laboratory Testing Services (0604)	not covered	May 15, 2026	payer document

Medicaid fee-for-service

AZ: $475.71 (outpatient_hospital), effective Oct 1, 2021
IL: $101.80 (practitioner), effective Jul 1, 2026
IN: $0.00 (professional, facility), effective Jan 1, 2010
KS: $426.67 (default, Exempt Physician), effective Jul 1, 2023
KY: $0.00 (physician, facility), effective Jan 1, 2026
LA: $9.70 (lab_radiology), effective Jul 1, 2012
MS: $637.10 (comprehensive), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
OH: $999.59 (lab), effective Jan 1, 2018
OK: $0.00 (physician, non-facility), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $356.30 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.

86891 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86891

Payer coverage policies that name 86891

Medicaid fee-for-service

`86891` CPT® code: payer coverage and prior authorization