88319 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 88319

Payer coverage policies that name 88319

88319 appears in 5 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna.

PayerPolicyRole in policyReviewedDocument
AetnaBiochemical Markers of Bone Remodeling (0562)not coveredAug 21, 2026payer document
AetnaTransthyretin-Mediated (ATTR) Amyloidosis (0939)listed, no stance (range 88312-88319)Aug 10, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 88300-88399)Mar 1, 2024payer document
BlueCross BlueShield of South CarolinaLaboratory/Pathology Services (CAM 472)listed, no stanceJan 1, 2026payer document
CignaLaboratory Testing Services (0604)not coveredMay 15, 2026payer document

Medicaid fee-for-service

  • AZ: $475.71 (outpatient_hospital), effective Oct 1, 2021
  • CO: $21.48 (chp_plus, non-facility), effective Jul 1, 2026
  • IL: $84.75 (practitioner), effective Apr 1, 2024
  • IN: $20.79 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $65.68 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $21.95 (lab), effective Jan 1, 2026
  • MA: $19.61 (physician_surgery), effective May 1, 2024
  • MS: $104.30 (comprehensive), effective Jul 1, 2026
  • ND: $119.41 (physician), effective Aug 1, 2026
  • NE: $29.48 (physician, non-facility), effective Jul 1, 2026
  • NY: $35.54 (lab), effective Aug 1, 2026
  • OH: $96.79 (lab), effective Apr 1, 2025
  • OK: $89.02 (physician, non-facility), effective Jul 1, 2026
  • TX: $20.14 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), facility), effective Apr 1, 2017
  • VA: $114.29 (medical), effective Jul 1, 2026
  • VT: $625.58 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $15.10 (kidneycenters), effective Jul 1, 2026
  • WY: $356.30 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.