87635 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 87635

Payer coverage policies that name 87635

87635 appears in 9 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Cigna, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaInfluenza Rapid Diagnostic Tests (0476)covered if criteria are metJul 24, 2026payer document
AetnaPolymerase Chain Reaction Testing: Selected Indications (0650)covered if criteria are metSep 10, 2026payer document
Blue Cross & Blue Shield of MississippiCoronavirus Disease 2019 Covid19 Reverse Transcriptionpolymerase Chain Reaction Rtpcr Testing (L.5.01.545)covered if criteria are metpayer document
Blue Cross NCCoronavirus Testing in the Outpatient Setting AHS - G2174listed, no stanceJul 1, 2025payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 87003-87999)Mar 1, 2024payer document
Blue Shield of CaliforniaIdentification of Microorganisms Using Nucleic Acid Probes (2.04.10)listed, no stancepayer document
BlueCross BlueShield of South CarolinaCoronavirus Testing in the Outpatient Setting (CAM 380)listed, no stanceJul 1, 2026payer document
CignaCOVID-19: In Vitro Diagnostic Testing (0557)covered if criteria are metMay 15, 2026payer document
RegenceCOVID-19 Testing (Laboratory 74)listed, no stanceJun 1, 2026payer document

Medicaid fee-for-service

  • AZ: $51.31 (lab), effective Oct 1, 2026
  • CO: $43.61 (lab_cdl), effective Apr 1, 2026
  • FL: $30.42 (lab_independent, non-facility), effective Jan 1, 2026
  • IN: $43.61 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 30, 2020
  • KS: $32.71 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $51.31 (lab), effective Jan 1, 2026
  • LA: $43.61 (lab_radiology), effective Jul 1, 2025
  • MS: $46.18 (comprehensive), effective Jul 1, 2026
  • ND: $51.31 (physician), effective Aug 1, 2026
  • NE: $51.31 (lab), effective Jul 1, 2026
  • NY: $30.79 (lab), effective Aug 1, 2026
  • OH: $38.48 (lab), effective Apr 1, 2025
  • OK: $45.64 (physician, non-facility), effective Jul 1, 2026
  • TX: $47.72 (hhsc_family_planning_program, Hhsc Family Planning Program), effective Sep 1, 2024
  • VA: $45.15 (medical), effective Mar 13, 2020
  • VT: $50.03 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $41.05 (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.