What insurance policy changes affect CPT 81599?

There are 13 tracked policy changes affecting CPT 81599, including updates from Ambetter, Humana, BlueCross BlueShield of South Carolina. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 81599?

Payers that have issued tracked updates for CPT 81599 include: Ambetter, Humana, BlueCross BlueShield of South Carolina, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 81599 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 81599. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 81599?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

81599 Insurance Policy Changes

CPT 81599 is referenced in 13 tracked payer policy changes from Ambetter, Humana, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81599 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact
Clinical and Payment Policy Updates, Effective 10/9/2026 (PDF)
Ambetter·Effective Oct 9, 2026
Home State Health Plan implemented 10 new and 2 updated clinical payment policies effective October 9, 2026, spanning infectious disease testing (respiratory, multi-system, dermatologic, gastroenterologic, genitourinary, vector-borne), genetic testing, skin substitutes, and genitourinary diagnostic criteria. Key changes include new medical necessity criteria for syndromic/multiplex respiratory panels, infectious disease pathogen testing, Concert genetic testing with updated language from "investigational" to "current evidence does not support," and updated skin substitute graft requirements mandating wound care specialist management. Billing teams must identify which policies apply to their patient populations and implement corresponding coding and documentation requirements.
High impact
Molecular Markers in Fine Needle Aspirates of Thyroid Nodules - Medicare Advantage (Revised)
Humana·Effective Sep 10, 2026
This revised Medicare Advantage policy (effective 09/10/2026) establishes coverage criteria for molecular marker testing in fine needle aspirates of thyroid nodules, including Afirma GSC, ThyGeNext/ThyraMIRv2, and ThyroSeq v3 GC tests. Coverage is determined by applicable MAC Local Coverage Determinations (LCDs) in each jurisdiction, with specific criteria varying by geographic region and test type.
High impact
Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - MEDICAID - FLORIDA (Revised)
Humana·Effective Apr 6, 2026
Humana Florida Medicaid has issued a comprehensive policy stating that molecular diagnostic assays and breath testing for transplant rejection are NOT covered. This includes gene expression profiling, donor-derived cell-free DNA tests, breath testing, HLA testing, and urine-based tests for allograft rejection.
High impact
2025 August Medical Policy Updates
BlueCross BlueShield of South Carolina·Effective Aug 28, 2025
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 44 updated medical policies effective August 28, 2025. Most are routine annual reviews with no coverage intent changes but updated evidence and references. However, several policies contain actionable billing code changes and expanded coverage criteria: CAM 127 (Hepatitis Testing) adds HCPCS G0567 and expands coverage for immunosuppressant therapy patients; CAM 277 (Serum Tumor Markers) removes CPT 83615; multiple genetic testing policies add or remove CPT codes; and CAM 320 (Familial Hypercholesterolemia) was completely rewritten with new coverage criteria. Billing teams must immediately update systems for code additions/removals and expanded testing criteria.
Medium impact
Molecular Biomarker Testing for Noncancer Indications - MEDICAID - FLORIDA (Revised)
Humana·Effective Sep 2, 2026
Humana Florida Medicaid has revised its molecular biomarker testing policy for noncancer indications, effective September 2, 2026. The policy explicitly denies coverage for Gene Expression Profiling (GEP) for coronary artery disease (CPT 81493) and Multianalyte Assay with Algorithmic Analysis (MAAA) for rheumatoid arthritis risk prediction (CPT 81490), citing insufficient evidence. However, molecular pathology testing (CPT 81479) and unlisted MAAA (CPT 81599) remain eligible for coverage when they meet specific clinical validity criteria.
Medium impact
Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage (Revised)
Humana·Effective Jun 1, 2026
Humana Medicare Advantage has established new coverage criteria for noninvasive hepatic fibrosis tests, effective June 1, 2026. The policy covers FIB-4 index testing without restrictions and MRE with specific clinical criteria including chronic liver disease diagnosis or inconclusive FIB-4 results.
Medium impact
Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - MEDICAID - SOUTH CAROLINA (Revised)
Humana·Effective Mar 9, 2026
Humana Medicaid in South Carolina now covers only specific AlloSure Heart and Kidney donor-derived cell-free DNA tests for transplant rejection monitoring with strict frequency limits. All other molecular diagnostic assays, breath testing, and gene expression tests for transplant rejection are not covered.
Medium impact
Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - MEDICAID - KENTUCKY (Revised)
Humana·Effective Nov 12, 2025
Humana Kentucky Medicaid will not cover any molecular diagnostic assays or breath testing for transplant rejection effective November 12, 2025. All related testing including gene expression profiling, donor-derived cell-free DNA tests, and HLA testing for rejection monitoring are excluded from coverage.
Medium impact
Gene Expression Profiling for Cutaneous Melanoma
Blue Cross & Blue Shield of Mississippi·Effective Oct 1, 2025
This policy update declares all gene expression profiling tests for melanoma evaluation as investigational and non-covered, including specific tests like Pigmented Lesion Assay, myPath Melanoma, and DecisionDx-Melanoma. A new CPT code 0578U was added effective 10/01/2025 for a melanoma gene expression test, but it remains investigational.
Medium impact
2025 August Medical Policy Updates
BlueCross BlueShield of South Carolina·Effective Aug 28, 2025
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released August 2025 medical policy updates affecting 48 policies. Most are annual reviews with no coverage intent changes but updated evidence, references, and rationale. Key changes include: two hematopoietic cell transplant policies archived; hepatitis testing expanded to immunosuppressed patients with new HCPCS code G0567; serum tumor markers coverage criteria broadened; familial hypercholesterolemia testing completely rewritten with new clinical suspicion definitions; and multiple genetic testing policies updated with new CPT codes and expanded repeat testing criteria.
Medium impact
Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
BCBS Mississippi considers serum biomarker panel testing with proprietary algorithms for diagnosing systemic lupus erythematosus and other connective tissue diseases as investigational and not covered. This affects specific laboratory tests including Avise tests and related CPT codes that will be denied if billed.
Low impact
Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - SOUTH CAROLINA (Revised)
Humana·Effective Aug 26, 2026
Humana updated its South Carolina Medicaid policy for genetic testing used to diagnose inherited conditions. The policy establishes coverage criteria for molecular pathology testing (CPT 81479) and multianalyte assays with algorithmic analysis (CPT 81599), requiring that tests demonstrate analytic validity, clinical validity, clinical utility based on peer-reviewed evidence, and must change clinical management. This is a routine annual review update effective August 26, 2026, with no substantive coverage changes from prior versions.
Low impact
Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
This policy establishes that genetic testing for the LPA rs3798220 allele (LPA-Aspirin Genotype) to guide aspirin treatment decisions is considered investigational and not covered. The policy clarifies that this testing should not be billed as a covered service.

All billing codes J3590 99213 99214 99212 99202 99203

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Clinical and Payment Policy Updates, Effective 10/9/2026 (PDF)

Molecular Markers in Fine Needle Aspirates of Thyroid Nodules - Medicare Advantage (Revised)

Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - MEDICAID - FLORIDA (Revised)

2025 August Medical Policy Updates

Molecular Biomarker Testing for Noncancer Indications - MEDICAID - FLORIDA (Revised)

Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage (Revised)

Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - MEDICAID - SOUTH CAROLINA (Revised)

Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - MEDICAID - KENTUCKY (Revised)

Gene Expression Profiling for Cutaneous Melanoma

2025 August Medical Policy Updates

Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases

Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - SOUTH CAROLINA (Revised)

Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment