86950 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 86950

Payer coverage policies that name 86950

86950 appears in 22 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

PayerPolicyRole in policyReviewedDocument
AetnaRecurrent Pregnancy Loss (0348)not coveredJun 23, 2026payer document
Blue Cross & Blue Shield of MississippiDonor Lymphocyte Infusion For Malignancies Treated With An Allogeneic Hematopoietic Stemcell Transplant (L.2.03.402)covered if criteria are metpayer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 86000-86999)Mar 1, 2024payer document
CenteneDonor Lymphocyte Infusion (CP.MP.101)covered if criteria are metFeb 1, 2025payer 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: $40.52 (lab), effective Oct 1, 2026
  • CO: $54.64 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $46.80 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $25.70 (practitioner), effective Jul 1, 2026
  • IN: $70.71 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
  • KS: $97.10 (default, Exempt Physician), effective Jul 1, 2023
  • LA: $31.37 (lab_radiology), effective Jul 1, 2012
  • MS: $129.38 (comprehensive), effective Jul 1, 2026
  • ND: $0.00 (physician), effective Aug 1, 2026
  • NE: $168.93 (physician, non-facility), effective Jul 1, 2026
  • OH: $28.58 (lab), effective Jan 1, 2018
  • OK: $0.00 (physician, non-facility), effective Jul 1, 2026
  • TX: $42.85 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Sep 1, 2025
  • VA: $55.00 (medical), effective Jan 1, 1993
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $3.74 (physician, facility), effective Jul 1, 2026
  • WY: $75.35 (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.