CPT 86300 is referenced in 3 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 86300 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Multiple medical policy updates take effect July 1, 2025, affecting various testing services and prior authorization requirements. Key changes include biomarker testing moving from prior auth required to not covered for Medicare Advantage, phototherapy becoming covered for Medicare Advantage, and numerous genetic/molecular testing codes having prior authorization removed or coverage criteria changes.
Multiple medical policy updates effective between March-May 2026, including expanded covered diagnosis codes for various lab tests, changes to prior authorization requirements for certain genetic tests, and restrictions on who can perform psychological testing. Most changes expand coverage for existing CPT codes while some procedures move from prior auth to non-covered status.
Aetna considers tumor marker testing medically necessary, unless otherwise stated, for the indication-specific tumor markers listed in the policy, such as ALK testing for non-small cell lung cancer, BRAF testing for metastatic colorectal cancer, and CA 125 testing for epithelial ovarian, fallopian tube or primary peritoneal cancer. Breast adjuvant tests (Oncotype Dx Breast, MammaPrint, Breast Cancer Index, EndoPredict, PAM50 ROR, and uPA with PAI-1) are medically necessary only when the breast cancer is nonmetastatic, estrogen receptor positive and HER2 negative, adjuvant chemotherapy is not precluded by another factor, and the member and physician have discussed the potential results and agree to use them to guide therapy. Aetna considers circulating tumor cell assays for all indications, ctDNA tests for any indication other than small non-small cell lung cancer panels, MRD testing for indications not listed as medically necessary, and use of more than one type of breast adjuvant test experimental, investigational, or unproven.
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