87110 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 87110

Payer coverage policies that name 87110

87110 appears in 7 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaInfertility (0327)covered if criteria are metJul 16, 2026payer document
Blue Cross NCDiagnostic Testing of Sexually Transmitted Infections AHS – G2157listed, no stanceApr 1, 2026payer document
Blue Cross NCPrenatal Screening (Nongenetic) AHS - G2035listed, no stanceOct 1, 2025payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 87003-87999)Mar 1, 2024payer document
BlueCross BlueShield of South CarolinaDiagnostic Testing of Most Common Sexually Transmitted Infections (CAM 209)
Number
listed, no stanceApr 1, 2026payer document
Premera Blue CrossPreventive Carecovered if criteria are metSep 21, 2026payer document
UnitedHealthcarePreventive Care Services (MP.016.59)
Screening | Chlamydia Infection Screening: | Requires a Pregnancy Diagnosis Code
listed, no stanceJul 1, 2026payer document

Medicaid fee-for-service

  • AZ: $19.60 (lab), effective Oct 1, 2026
  • CO: $19.60 (lab_cdl), effective Oct 1, 2025
  • FL: $10.58 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $33.70 (practitioner), effective Mar 1, 2013
  • IN: $16.66 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024
  • KS: $14.70 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $19.60 (lab), effective Jan 1, 2026
  • LA: $19.49 (family_planning_clinic), effective Feb 1, 2013
  • MS: $17.64 (comprehensive), effective Jul 1, 2026
  • ND: $19.60 (physician), effective Aug 1, 2026
  • NE: $19.60 (lab), effective Jul 1, 2026
  • NY: $8.23 (lab), effective Aug 1, 2026
  • OH: $14.70 (lab), effective Apr 1, 2021
  • OK: $17.43 (physician, non-facility), effective Jul 1, 2026
  • TX: $18.23 (hhsc_family_planning_program, Hhsc Family Planning Program), effective Mar 1, 2021
  • VA: $8.69 (medical), effective Jul 1, 2014
  • VT: $19.11 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $15.68 (family_planning, 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.