86153 Insurance Policy Changes

CPT 86153, in plain terms, covers Counts cells in a sample and records them by a physician's interpretation. Used for analysis of cells found in a sample, rather than the lab tally itself. CPT 86153 is referenced in 7 tracked payer policy changes from Regence BlueShield, Humana, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 86153 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 86153 on AAPC

Regence BlueShield · Effective Oct 1, 2026Medium impact
Circulating Tumor DNA and Circulating Tumor Cells for Management (Liquid Biopsy) of Solid Tumor Cancers
Cell-free tumor DNA testing in blood for targeted treatment selection is considered medically necessary when either advanced or metastatic ER-positive, HER2-negative breast cancer is present, or when clinical documentation shows tissue-based testing cannot be performed and the test includes at least one gene with an FDA-approved targeted therapy for that cancer indication. Cell-free DNA testing for targeted treatment selection is investigational when those criteria are not met, including urine tests. Cell-free DNA and circulating tumor cell testing for all other solid tumor indications, including measurable residual disease testing and cancer screening in asymptomatic individuals, is considered investigational.
Humana · Effective Aug 3, 2026Medium impact
Liquid Biopsy - Medicare Advantage (Revised)
Humana's Medicare Advantage Liquid Biopsy coverage policy was revised with an effective date of 2026-08-03, and its updated coding information applies from that date. Under the policy, specific plasma-based tests are medically reasonable and necessary when their listed criteria are met, including that tissue-based multigene panel testing is infeasible or, for non-small cell lung cancer, has shown no actionable mutations. The policy states that CellSearch Circulating Multiple Myeloma Cell Test (0337U), LungLB (0317U) and DEPArray HER2 Test (0009U) are not considered medically reasonable and necessary.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) 2.02.56
Excellus policy 2.02.56 Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) has a current effective date of February 19, 2026, and its 02/19/26 annual review states that policy intent is unchanged. Circulating tumor DNA analysis is considered medically appropriate only when it is used to direct targeted therapy, as an alternative to tissue biopsy when repeat invasive biopsy is contraindicated or there is not enough tissue, when the results will guide management, and when the test has FDA approval for the tumor type or disease site, and only for the listed cancers and gene targets. Liquid biopsy is investigational for all other indications, and comprehensive genomic profiling tests such as FoundationOne Liquid CDx and Guardant 360 are considered investigational.
Sentara Health Plans · Effective Aug 1, 2025Medium impact
Authorization Updates - Effective August 1, 2025
Sentara Health Plans' authorization updates took effect August 1, 2025, and on that date several Commercial and Medicaid policies were archived, including brachytherapy and proton beam radiation therapy. Prior authorization was removed for codes 61781, 61782 and 61783 (Commercial and Medicaid), 84112, 98975, 98976, 98977, 98978, 98980 and 98981 (Commercial, Medicaid and Medicare), 99473 and 99474 (Medicare), 0091U, 86152 and 86153 (Commercial, Medicaid and Medicare), and S9110 (Medicaid). Separate authorization updates took effect January 1, 2025 and July 1, 2025, and authorization is required with hour limits for a group of psychological and neuropsychological testing codes for Commercial plans as of August 1, 2025.
Sentara Health Plans · Effective Jul 1, 2025Medium impact
Summer 2025 Authorization Updates
Sentara Health Plans notified providers of summer 2025 authorization updates with go-live dates of July 1, 2025, August 1, 2025 and October 1, 2025. Many policies had criteria updated for Commercial and Medicaid, while Medicare continued to use the LCD and NCD policies listed for each service. Several policies were archived, and prior authorization was removed for codes including 61781, 61782 and 61783 for Commercial and Medicaid.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Metastatic Colorectal Cancer (KRAS, NRAS, BRAF, and HER2)
An update dated 01/15/2025 added NTRK gene fusion testing as medically necessary for individuals with metastatic colorectal cancer when it is used to select individuals for treatment with FDA-approved therapies. KRAS, NRAS, BRAF, NTRK, or HER2 testing of tumor tissue may be considered medically necessary for that purpose, and all other uses of that testing are considered investigational. Circulating tumor DNA testing (liquid biopsy) to guide treatment in metastatic colorectal cancer is considered investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Non-Small-Cell Lung Cancer (EGFR, ALK, BRAF, ROS1, RET, MET, KRAS, NTRK)
Somatic biomarker testing may be considered medically necessary in non-small-cell lung cancer to predict treatment response to FDA-approved targeted therapy for EGFR, ALK, BRAF V600E, ROS1, KRAS, RET, MET exon 14 skipping, and NTRK fusions when the individual meets the policy criteria. Plasma testing with an FDA-approved companion diagnostic plasma test may be considered medically necessary as an alternative to tissue biopsy for several of these genes, and for oncogenic driver variants when there is not sufficient tissue for standard molecular testing, with follow-up tissue-based analysis planned if no driver variant is found. Analysis of these genes in other situations, including plasma testing for BRAF V600E, ROS1 and RET, is considered investigational.

Watch 86153

Get one email when a payer policy names 86153, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

REFERENCE DATA

Payers with rules3

Payers requiring prior auth3

BCBS Michigan · Effective October 13, 2026
Prior authorization required in some cases
BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)
Excellus BlueCross BlueShield · Effective October 1, 2026
Prior authorization required
Excellus BCBS utilization management standard clinical review preauthorization list
Anthem BCBS · Effective September 1, 2026
Prior authorization required in some cases
Virginia Local Precertification/Prior Authorization List (HMO & EPO)

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for 86153?

Anthem BCBS lists 86153 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.

Does BCBS Michigan require prior authorization for 86153?

BCBS Michigan lists 86153 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does Excellus BlueCross BlueShield require prior authorization for 86153?

Excellus BlueCross BlueShield lists 86153 on Excellus BCBS utilization management standard clinical review preauthorization list for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 86153?

There are 7 tracked policy changes affecting CPT 86153, including updates from Regence BlueShield, Humana, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 86153?

Payers that have issued tracked updates for CPT 86153 include: Regence BlueShield, Humana, Excellus BlueCross BlueShield, Sentara Health Plans, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 86153 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 86153. 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 86153?

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.

See every payer rule for 86153

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 86153 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

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.

Create a free alert How Policy Monitoring works

Circulating Tumor DNA and Circulating Tumor Cells for Management (Liquid Biopsy) of Solid Tumor Cancers

Liquid Biopsy - Medicare Advantage (Revised)

Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) 2.02.56

Authorization Updates - Effective August 1, 2025

Summer 2025 Authorization Updates

Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Metastatic Colorectal Cancer (KRAS, NRAS, BRAF, and HER2)

Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Non-Small-Cell Lung Cancer (EGFR, ALK, BRAF, ROS1, RET, MET, KRAS, NTRK)

Prior authorization required in some cases

Prior authorization required