87650 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 87650

Payer coverage policies that name 87650

87650 appears in 6 coverage policies from Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna.

PayerPolicyRole in policyReviewedDocument
Blue Cross & Blue Shield of MississippiIdentification Of Microorganisms Using Nucleic Acid Probescovered if criteria are metpayer document
Blue Cross Blue Shield of MassachusettsIdentification of Microorganisms (555)listed, no stancepayer document
Blue Cross NCBeta-Hemolytic Streptococcus Testing AHS – G2159listed, 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 Carolinaβ-Hemolytic Streptococcus Testing (CAM 211)
86581 (effective 01/01/2025) | Streptococcus pneumoniae antibody (IgG), serotypes, multiplex immunoassay, quantitative
listed, no stanceOct 1, 2025payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 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: $12.78 (default, Exempt Physician), effective Jul 1, 2023
  • 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
  • NY: $6.65 (lab), effective Aug 1, 2026
  • OH: $15.04 (lab), effective Apr 1, 2021
  • OK: $17.84 (physician, non-facility), effective Jul 1, 2026
  • VA: $20.05 (medical), effective Jan 1, 2020
  • VT: $19.55 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $16.04 (kidneycenters), 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.