CPT 85385 is referenced in 2 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island and BCBS Arizona. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 85385 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Multiple medical policies are changing effective February 1, 2026, with significant coverage expansions for cardiovascular biomarker testing (CPT 85384, 85385) and bronchial valves, plus numerous additions of covered ICD-10 codes across various services. Several prior authorization requirements are shifting to online authorization tools while some digital health therapies are moving from not medically necessary to contract exclusions.
Blue Cross Blue Shield of Arizona's medical policy 'Analyte Testing in Risk Assessment and Management of Cardiovascular Disease' (original, current and last-criteria-revision effective date 10/27/26) sets coverage criteria: a single lipoprotein(a) test for atherosclerotic CVD risk assessment and apolipoprotein B in patients on lipid-lowering therapy (with one listed qualifying diagnosis) are medically necessary, while hs-CRP testing (with three documentation elements), other non-traditional lipid/non-lipid analytes, lipoprotein-associated phospholipase A2, and CVD risk panels are described as experimental or investigational when specified criteria are met. Billing staff should align orders, documentation and claim coding for these analytes with the stated criteria.
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