CPT 81433 is referenced in 3 tracked payer policy changes from Aetna, Premera Blue Cross, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81433 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Aetna updated their National Precertification List with multiple new drug requirements and removed precertification for BRCA genetic testing. Several new specialty drugs now require precertification with staggered effective dates from March through April 2025, and new claim edits will be implemented starting July 1, 2025.
Premera's January 2025 update adds Carelon imaging, genetic testing and radiation oncology guideline changes for dates of service on and after April 20, 2025, and adds new Insulin Therapy and SGLT2 Inhibitors pharmacy policies effective January 1, 2025. It also adds Kisunla to the amyloid antibody policy and lists coding updates that now require review for medical necessity and prior authorization, including amyloid antibody code J0175, folate antimetabolite code J9292, and sickle cell disease code J3392.
Germline genetic testing for BRCA1, BRCA2 and PALB2 variants to guide platinum-based chemotherapy selection in previously untreated individuals with locally advanced or metastatic pancreatic cancer may be considered medically necessary, and testing for BRCA1 and BRCA2 variants to guide olaparib (Lynparza) selection in individuals with pancreatic cancer may also be considered medically necessary. Testing for ATM, CDKN2A, EPCAM, MMR genes, STK11 and TP53 in individuals with pancreatic cancer is considered investigational unless another policy's criteria are met, and the same applies to asymptomatic high-risk individuals tested for these genes plus BRCA1, BRCA2 and PALB2. The 07/31/2026 update changed the policy description, removed deleted CPT codes 81433 and 81436, and left the policy statements unchanged.
Watch 81433
Get one email when a payer policy names 81433, 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 81433
Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 81433 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.