87475 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 87475

Payer coverage policies that name 87475

87475 appears in 8 coverage policies from Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
Blue Cross & Blue Shield of MississippiIntravenous Antibiotic Therapy And Associated Diagnostic Testing For Lyme Diseasecovered if criteria are metpayer document
Blue Cross Blue Shield of MassachusettsIdentification of Microorganisms (555)unproven / investigationalpayer document
Blue Cross Blue Shield of MassachusettsIntravenous Antibiotic Therapy and Associated Diagnostic Testing for Lyme Disease (171)listed, no stancepayer document
Blue Cross NCLyme Disease Testing AHS – G2143listed, no stanceApr 1, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 87003-87999)Mar 1, 2024payer document
BlueCross BlueShield of South CarolinaLyme Disease Testing (CAM 159)
Code Number
listed, no stanceApr 1, 2026payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document
Premera Blue CrossLyme Disease Testinglisted, no stanceApr 1, 2026payer document

Medicaid fee-for-service

  • AZ: $20.05 (lab), effective Oct 1, 2026
  • CO: $20.05 (lab_cdl), effective Oct 1, 2025
  • FL: $10.83 (lab_independent, non-facility), effective Jan 1, 2026
  • IL: $20.05 (practitioner), effective Apr 1, 2024
  • IN: $17.04 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $7.50 (default, Exempt Physician), effective Jan 1, 1998
  • KY: $20.05 (lab), effective Jan 1, 2026
  • LA: $20.05 (lab_radiology), effective Jan 1, 2020
  • MS: $18.05 (comprehensive), effective Jul 1, 2026
  • ND: $20.05 (physician), effective Aug 1, 2026
  • NE: $20.05 (lab), effective Jul 1, 2026
  • OH: $15.04 (lab), effective Apr 1, 2021
  • VA: $20.05 (medical), effective Jan 1, 2020
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $16.04 (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.