Payer policies › CPT 9507695076 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 95076 Payer coverage policies that name 95076 95076 appears in 6 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Centene.
Payer Policy Role in policy Reviewed Document Aetna Allergy and Hypersensitivity (0038) covered if criteria are met Mar 10, 2026 payer document Aetna Autism Spectrum Disorders (0648) not covered Oct 2, 2025 payer document Aetna Omalizumab (0670) listed, no stance (range 95004-95079) Aug 21, 2026 payer document Blue Cross & Blue Shield of Mississippi Allergy Testing (L.2.01.428) listed, no stance payer document Blue Cross NC Allergy Skin and Challenge Testing listed, no stance Nov 1, 2025 payer document Centene Allergy Testing and Therapy (CP.MP.100) covered if criteria are met Sep 1, 2023 payer document
Medicaid fee-for-service AZ: $52.65 (outpatient_hospital, RF133), effective Oct 1, 2025 CO: $100.19 (chp_plus, non-facility), effective Jul 1, 2026 FL: $50.33 (physician, facility), effective Jan 1, 2026 IL: $49.24 (practitioner), effective Apr 1, 2024 IN: $58.13 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $58.54 (physician, facility), effective Jan 1, 2026 LA: $97.45 (professional), effective Jul 1, 2025 MA: $54.27 (physician_medicine, facility), effective May 1, 2024 MS: $101.56 (comprehensive), effective Jul 1, 2026 ND: $137.05 (physician), effective Aug 1, 2026 NE: $115.16 (physician, non-facility), effective Jul 1, 2026 NY: $38.94 (physician_medicine, facility), effective Jul 1, 2026 OH: $56.65 (physician, facility), effective Jan 1, 2024 OK: $57.03 (physician, facility), effective Jul 1, 2026 TX: $96.57 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2025 VA: $54.11 (medical, facility), effective Jul 1, 2026 VT: $289.74 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $36.69 (physician, facility), effective Jul 1, 2026 WY: $165.02 (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.