87563 CPT® code: payer coverage and prior authorization7 of 7 payer prior-auth lists that name 87563 require prior authorization or set conditions: Molina Healthcare of Ohio, Molina Healthcare of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Texas | STAR | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR+PLUS | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) | TX | prior auth required | Apr 1, 2020 | Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Apr 1, 2020 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
87563 appears in 8 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Cigna.
| 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 & Blue Shield of Mississippi | Identification Of Microorganisms Using Nucleic Acid Probes | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Pathogen Panel Testing (L.2.04.456) | not covered | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Sexually Transmitted Infections Testing — Professional | listed, no stance | payer document | |
| Blue Cross Blue Shield of Massachusetts | Identification of Microorganisms (555) | listed, no stance | payer document | |
| Blue Cross NC | Diagnostic Testing of Sexually Transmitted Infections AHS – G2157 | listed, no stance | Apr 1, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 87003-87999) | Mar 1, 2024 | payer document |
| Cigna | Laboratory Testing Services (0604) | not covered | May 15, 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.