88272 CPT® code: payer coverage and prior authorization4 of 4 payer prior-auth lists that name 88272 require prior authorization or set conditions: UnitedHealthcare, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 | |
| 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 |
88272 appears in 26 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Alzheimer's Disease Tests (0349) | listed, no stance (range 88271-88275) | Aug 4, 2026 | payer document |
| Aetna | Atezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (0909) | listed, no stance | Sep 28, 2026 | payer document |
| Aetna | Breast and Ovarian Cancer Susceptibility Gene Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy (0227) | covered if criteria are met (range 88271-88275) | Apr 14, 2026 | payer document |
| Aetna | Cardiovascular Disease Risk Tests (0381) | not covered (range 88271-88275) | Aug 25, 2026 | payer document |
| Aetna | Celiac Disease Laboratory Testing (0561) | listed, no stance (range 88271-88275) | Aug 3, 2026 | payer document |
| Aetna | Cervical Cancer Screening and Diagnosis (0443) | not covered (range 88271-88275) | Jul 22, 2026 | payer document |
| Aetna | Colonoscopy, Colorectal Cancer Screening, and Related Procedures (0516) | listed, no stance (range 88271-88275) | Aug 20, 2026 | payer document |
| Aetna | Genetic Testing (0140) Genetic testing for dominant polycystic kidney disease (PKD1 and PKD2) | covered if criteria are met (range 88271-88275) | Aug 18, 2026 | payer document |
| Aetna | Growth Hormone (GH) and Growth Hormone Antagonists (0170) | listed, no stance (range 88271-88275) | Jun 26, 2026 | payer document |
| Aetna | Infertility (0327) | covered if criteria are met | Jul 16, 2026 | payer document |
| Aetna | Invasive Prenatal Diagnosis of Genetic Diseases (0358) | covered if criteria are met (range 88271-88299) | May 22, 2026 | payer document |
| Aetna | Magnetic Resonance Imaging (MRI) of the Breast (0105) | listed, no stance (range 88271-88275) | Aug 6, 2026 | payer document |
| Aetna | Multiple Sclerosis (0264) | listed, no stance (range 88271-88275) | Sep 10, 2026 | payer document |
| Aetna | Pharmacogenetic and Pharmacodynamic Testing (0715) | listed, no stance (range 88271-88275) | Oct 8, 2026 | payer document |
| Aetna | Prenatal Care Provided by Primary Care Physicians (0047) | listed, no stance (range 88271-88275) | Oct 6, 2026 | payer document |
| Aetna | Prostate Cancer Screening (0521) | listed, no stance | Aug 28, 2026 | payer document |
| Aetna | Recurrent Pregnancy Loss (0348) | covered if criteria are met (range 88271-88275) | Jun 23, 2026 | payer document |
| Aetna | Tourette's Syndrome (0480) | not covered (range 88271-88275) | Jul 24, 2026 | payer document |
| Aetna | Trastuzumab Products (0313) | listed, no stance (range 88271-88275) | Jun 8, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Germline Genetic Testing For Hereditary Breastovarian Cancer Syndrome And Other Highrisk Cancers Brca1 Brca2 Palb2 | covered if criteria are met (range 88271-88275) | payer document | |
| Blue Cross NC | Esophageal Pathology Testing AHS - M2171 | listed, no stance | Apr 1, 2026 | payer document |
| Blue Cross NC | General Genetic Testing, Somatic Disorders AHS - M2146 | listed, no stance | Jan 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Esophageal Pathology Testing (CAM 242) Number | listed, no stance | Apr 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Genomic Testing for Hematopoietic Neoplasms (CAM 390) 88237 | Tissue culture for neoplastic disorders; bone marrow, blood cells | listed, no stance | Oct 1, 2025 | payer document |
| Cigna | Laboratory Testing Services (0604) | not covered | May 15, 2026 | payer document |
| Regence | Preimplantation Genetic Testing of Embryos (Genetic Testing 18) | listed, no stance (range 88271-88275) | May 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.