88264 CPT® code: payer coverage and prior authorization3 of 3 payer prior-auth lists that name 88264 require prior authorization or set conditions: UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare Community Plan | AHCCCS Complete Care (ACC) | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026 | |
| UnitedHealthcare Community Plan | ALTCS Developmentally Disabled | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | ALTCS Long Term Care | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026 |
88264 appears in 9 coverage policies from Aetna, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Autism Spectrum Disorders (0648) | covered if criteria are met | Oct 2, 2025 | payer document |
| Aetna | Comparative Genomic Hybridization (CGH) (0787) | listed, no stance | Nov 19, 2025 | payer document |
| Aetna | Genetic Testing (0140) Genetic testing for dominant polycystic kidney disease (PKD1 and PKD2) | covered if criteria are met (range 88245-88269) | Aug 18, 2026 | payer document |
| Aetna | Infertility (0327) | covered if criteria are met | Jul 16, 2026 | payer document |
| Aetna | Magnetic Resonance Imaging (MRI) of the Breast (0105) | listed, no stance (range 88245-88269) | Aug 6, 2026 | payer document |
| Aetna | Recurrent Pregnancy Loss (0348) | covered if criteria are met (range 88245-88269) | Jun 23, 2026 | payer document |
| Aetna | Tourette's Syndrome (0480) | not covered (range 88245-88269) | Jul 24, 2026 | payer document |
| Cigna | Laboratory Testing Services (0604) | not covered | May 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Medical Policies Moving to MCG Guidelines Spectrum Disorders (ASD) | 70460, 70470, 70496, 70551, | Disorders – Gene Panels | listed, no stance | Jan 1, 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.