CPT 87077 is referenced in 4 tracked payer policy changes from Harvard Pilgrim Health Care, Arkansas Blue Cross Blue Shield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 87077 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Point32Health consolidated multiple legacy payment policies into new integrated policies effective November 1, 2026, affecting Evaluation and Management, DME/Medical Supplies, Rehabilitation/Long-Term Acute Care, and Skilled Nursing Facility services across Harvard Pilgrim and Tufts Health plans. The payer also removed specific CPT codes from several laboratory policies and clarified modifier usage (PO and PN) for outpatient facility billing.
Arkansas Blue Cross revised coverage criteria for three laboratory testing policies effective 11/01/2026: (1) Nongenetic prenatal screening now covers only specific tests (blood type, Rh status, anemia, Group B strep, rubella, varicella immunity, and fetal fibronectin for preterm labor symptoms) with 40 procedure codes removed; (2) CRP/ESR inflammation testing expanded to cover 17 specific inflammatory conditions with defined frequency; (3) Alpha-1 antitrypsin testing removed 2 codes with no coverage criteria changes. Billing teams must identify and deny claims for removed codes and non-covered indications.
Arkansas Blue Cross implemented coding changes affecting three medical policies: prenatal screening codes 81001-86762 are no longer covered with pregnancy test diagnosis Z32.01, urine culture codes 87077-87186 are not covered with urge incontinence diagnosis N39.41, and thyroid testing is restricted for asymptomatic non-pregnant individuals during general exams.
Aetna considers anthrax vaccine medically necessary for pre-exposure prophylaxis in the groups the CDC's ACIP recommends, including decontamination personnel, laboratory workers who handle Bacillus anthracis, and military personnel deployed to high-risk areas. Anthrax vaccination for post-exposure prophylaxis is medically necessary after aerosolized exposure, while a single intravenous antitoxin dose is medically necessary for post-exposure prophylaxis only when antimicrobial drugs are not appropriate or not available. Anthrax vaccine and intravenous antitoxin drugs (raxibacumab, obiltoxaximab or AIGIV) are considered experimental, investigational, or unproven for all other indications.
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