Does Anthem BCBS require prior authorization for 86352?

Anthem BCBS lists 86352 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 86352?

BCBS Michigan lists 86352 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.

What insurance policy changes affect CPT 86352?

There are 8 tracked policy changes affecting CPT 86352, including updates from Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 86352?

Payers that have issued tracked updates for CPT 86352 include: Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when CPT 86352 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 86352. 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 86352?

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

86352 Insurance Policy Changes

CPT 86352 is referenced in 8 tracked payer policy changes from Aetna, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 86352 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Effective Dec 23, 2025High impact
Transplant Immune Cell Function Assays (CPB 0773, reviewed 2025-12-23)
Aetna has updated its transplant immune cell function assay policy (CPB 0773) to establish narrow coverage for the ImmuKnow Assay ONLY for adjudicating over-immunosuppression in transplant recipients with co-morbid infection or cancer. All other immune cell function assays and indications—including CMV risk stratification, rejection prediction, and post-transplant monitoring—are now classified as experimental/investigational and not covered. Billing teams must immediately stop billing these assays for non-covered indications to prevent claim denials.
Aetna · Identified Oct 29, 2026Medium impact
Transplant Immune Cell Function Assays (CPB 0773, reviewed 2026-10-28)
Aetna's CPB 0773 establishes coverage criteria for transplant immune cell function assays, covering only the ImmuKnow Assay (CPT 86352) for adjudicating over-immunosuppression in transplant recipients with co-morbid infection or cancer. All other immune cell function assays and most other indications of the ImmuKnow Assay are classified as experimental, investigational, or unproven and are not covered. Billing teams must verify medical necessity criteria before submitting claims to avoid denials.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Immune Cell Function Assay
Use of immune cell function assay testing to monitor and predict immune function after solid organ transplantation is investigational. Use of immune cell function assay testing to monitor and predict immune function after hematopoietic cell transplantation is also investigational, as is use for all other indications. The policy's investigational code list includes CPT 0018M, 81560, 82397, 86352 and 86353.
Independence Blue Cross · Identified Jun 25, 2026Low impact
MA06.018a, Immune Cell Function Assay
This is a reissue with no substantive changes to Independence Blue Cross Medicare Advantage policy MA06.018a. The policy continues to classify immune cell function assay (ImmuKnow) as experimental/investigational and non-covered for all indications, including transplant monitoring. Despite FDA clearance, the company maintains its position that safety and effectiveness cannot be established through peer-reviewed literature review.
Independence Blue Cross · Identified Jun 25, 2026Low impact
06.02.37a, Immune Cell Function Assay
This is a reissue with no substantive changes to Independence Blue Cross policy 06.02.37a. The policy maintains that immune cell function assays (CPT 86352) are considered experimental/investigational and are NOT covered for any indication, including transplant monitoring. The policy has been reissued annually since 2015 with no modifications to coverage status or guidelines.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA06.018a, Immune Cell Function Assay
This is a reissue with no changes to Independence Blue Cross Medicare Advantage policy MA06.018a. The policy maintains its longstanding position that immune cell function assays (ImmuKnow®) are considered experimental/investigational and are NOT covered for Medicare Advantage members in New Jersey, regardless of FDA clearance. No workflow changes are required.
Independence Blue Cross · Identified Jun 19, 2026Low impact
06.02.37a, Immune Cell Function Assay
Independence Blue Cross reissued Policy 06.02.37a with no substantive changes. The policy continues to classify Immune Cell Function Assay (CPT 86352) as experimental/investigational and not covered for all indications, including transplant monitoring. This is a routine annual review reissuance with no workflow impact.

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Transplant Immune Cell Function Assays (CPB 0773, reviewed 2025-12-23)

Transplant Immune Cell Function Assays (CPB 0773, reviewed 2026-10-28)

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

Immune Cell Function Assay

MA06.018a, Immune Cell Function Assay

06.02.37a, Immune Cell Function Assay