87484 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 87484 require prior authorization or set conditions: HealthSpring.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List |
87484 appears in 5 coverage policies from Aetna, Blue Cross NC, Cigna, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Polymerase Chain Reaction Testing: Selected Indications (0650) | covered if criteria are met | Sep 10, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 87003-87999) | Mar 1, 2024 | payer document |
| Blue Cross NC | Testing for Vector-Borne Infections AHS – G2158 | listed, no stance | Oct 1, 2025 | payer document |
| Cigna | Laboratory Testing Services (0604) | not covered | May 15, 2026 | payer document |
| Premera Blue Cross | Testing for Vector-Borne Infections | listed, no stance | Feb 6, 2026 | payer document |
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.