Does Anthem BCBS require prior authorization for 82131?

Anthem BCBS lists 82131 on Virginia Local Precertification/Prior Authorization List (HMO & EPO) for commercial plans, with conditions (list dated September 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 82131?

There are 3 tracked policy changes affecting CPT 82131, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 82131?

Payers that have issued tracked updates for CPT 82131 include: Aetna.

How do I get notified when CPT 82131 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 82131. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 82131?

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.

PAYER POLICY CHANGES

82131 Insurance Policy Changes

CPT 82131 is referenced in 3 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 82131 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Effective Feb 26, 2026Medium impact
Pegzilarginase-nbln (Loargys) (CPB 1101, reviewed 26-2026-06)
Aetna has issued a new Clinical Policy Bulletin (CPB 1101) effective immediately for Pegzilarginase-nbln (Loargys), a specialty enzyme replacement therapy for arginase 1 deficiency in patients ages 2-31. The policy establishes strict coverage criteria including precertification requirements, age/diagnostic restrictions, baseline arginine level thresholds (≥250 micromol/L), dosage caps (0.2 mg/kg weekly), and ongoing plasma arginine monitoring. All prescriptions require prior authorization through specialty pharmacy channels.
Aetna · Identified Aug 19, 2026Medium impact
Nonstandard Laboratory Test Panels (CPB 0499, reviewed 2026-08-03)
Aetna considers laboratory test panels experimental, investigational, or unproven when they include nonstandard tests that have no proven value. Panels are also considered experimental, investigational, or unproven when they include standard tests performed for persons without specific signs and symptoms warranting the test, or for indications that are not established. The policy names panels and tests from Aeron Life Cycles, Alletess Medical Laboratory, BioHealth, DiagnosTechs, Doctor's Data Lab, Great Plains Laboratory, Moleculera Labs, Physicians Lab and ZRT Laboratory as experimental, investigational, or unproven, and it lists other laboratories that perform non-standard panels considered experimental, investigational, or unproven. Certain tests are considered medically necessary in specific situations, such as urine porphyrins for persons with signs and symptoms of porphyria. There is no evidence that these laboratory test panels affect the management of afflicted individuals.
Aetna · Identified Aug 17, 2026Medium impact
Fetal Fibronectin, Inflammatory Biomarkers, and Salivary Hormone Testing for Preterm Labor (CPB 0166, reviewed 2026-04-21)
Aetna considers the fetal fibronectin (fFN) immunoassay medically necessary to evaluate pregnant women with symptoms of preterm labor who are considered high-risk for preterm delivery when amniotic membranes are intact, cervical dilation is less than 3 cm, sampling occurs no earlier than 24 weeks 0 days and no later than 34 weeks 6 days of gestation, and results will be available quickly enough to influence real-time decisions for suspected preterm labor. A repeat fFN immunoassay is medically necessary when the member meets all of the same criteria and remains symptomatic 2 or more weeks after a previous negative fFN immunoassay. Fetal fibronectin testing for routine screening of the general obstetric population, for asymptomatic high-risk women, for identifying optimal cerclage candidates, and following cervical cerclage insertion is experimental, investigational or unproven, as are the biomarker, inflammatory marker, proteomic, metabolomic and salivary hormone tests named for preterm birth prediction.

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Pegzilarginase-nbln (Loargys) (CPB 1101, reviewed 26-2026-06)

Nonstandard Laboratory Test Panels (CPB 0499, reviewed 2026-08-03)

Fetal Fibronectin, Inflammatory Biomarkers, and Salivary Hormone Testing for Preterm Labor (CPB 0166, reviewed 2026-04-21)

Prior authorization required in some cases

Does Anthem BCBS require prior authorization for 82131?

What insurance policy changes affect CPT 82131?

Which payers have updated policy for CPT 82131?

How do I get notified when CPT 82131 policy changes?

Why do payers change policies for CPT 82131?