CPT 81170 is referenced in 4 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island, Regence BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81170 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Blue Cross Blue Shield Rhode Island is implementing major policy changes effective January 1, 2026, including new prior authorization requirements for physical therapy after 14 visits, removing prior authorization from numerous cardiology/radiology procedures, and updating coverage for various genetic testing and specialty procedures. Multiple CPT codes are changing authorization status and coverage requirements across Medicare Advantage and commercial plans.
Effective October 1, 2026, a genetic panel test is considered investigational when there is not enough research to show that its genes or variants can be used to manage treatment decisions and improve net health outcomes, and the entire panel is then considered investigational, with or without optional add-on genes. Named panels from laboratories such as Blueprint Genetics, GeneDx, Invitae and Labcorp are listed as investigational, and some of them are reviewed under other cross-referenced policies.
BCR-ABL1 qualitative testing may be considered medically necessary for the diagnosis of chronic myeloid leukemia. Quantitative RT-PCR testing of BCR-ABL1 mRNA transcript levels may be considered medically necessary for monitoring treatment response and remission in CML and Philadelphia chromosome-positive ALL. Evaluation of ABL kinase domain single nucleotide variants for tyrosine kinase inhibitor resistance may be considered medically necessary when there is an inadequate initial response, any sign of loss of response, or, for CML, progression to the accelerated or blast phase.
Effective January 1, 2019, Tisagenlecleucel code Q2042 and breast MRI codes 77046, 77047, 77048 and 77049 are now reviewed by AIM Specialty Health and require prior authorization, and A9584 (iodine I-123 ioflupane) is now reviewed for medical necessity and requires prior authorization. Breast MRI codes 77058 and 77059 are no longer reviewed by AIM Specialty Health, and the CAR-T codes 0537T through 0540T are listed as not reviewed and noncovered. Effective January 4, 2019, a long list of genetic testing codes beginning with 81120 and 81121 is now reviewed by AIM Specialty Health and requires prior authorization.
Watch 81170
Get one email when a payer policy names 81170, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
See every payer rule for 81170
Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 81170 in one place.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.