Payer policies › CPT 8690486904 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 86904 Payer coverage policies that name 86904 86904 appears in 2 coverage policies from Blue Cross NC, Cigna.
Payer Policy Role in policy Reviewed 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: $16.34 (lab), effective Oct 1, 2026 CO: $13.61 (lab_cdl), effective Jul 1, 2026 FL: $8.82 (lab_independent, non-facility), effective Jan 1, 2026 IL: $12.40 (practitioner), effective Mar 1, 2013 IN: $13.89 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024 KS: $10.42 (default, Exempt Physician), effective Jul 1, 2023 KY: $16.34 (lab), effective Jan 1, 2026 LA: $13.89 (lab_radiology), effective Jul 1, 2025 MS: $44.80 (comprehensive), effective Jul 1, 2026 ND: $16.34 (physician), effective Aug 1, 2026 NE: $16.34 (lab), effective Jul 1, 2026 OH: $12.26 (lab), effective Apr 1, 2019 OK: $14.53 (physician, non-facility), effective Jul 1, 2026 VA: $5.13 (medical), effective Jul 1, 2014 VT: $45.81 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $13.07 (kidneycenters), effective Jul 1, 2026 WY: $26.09 (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.