CPT 87164, in plain terms, covers A microscope test using special lighting to look for spiral-shaped bacteria in body fluid samples. CPT 87164 is referenced in 3 tracked payer policy changes from Harvard Pilgrim Health Care, Capital Blue Cross, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 87164 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 87164 on AAPC
Point32Health (Harvard Pilgrim) is implementing extensive CPT code changes across multiple laboratory policies effective June 1, 2026, including removing 23 codes and adding 24 new codes across 11 different lab testing categories. A new prenatal testing policy for fetal aneuploidy is also being introduced.
Capital Blue Cross updated its medical policies with an effective date of March 1, 2026 unless otherwise indicated, and it delegated the medical specialty injectable policies to Prime Medical Pharmacy Solutions, which is making them more medication-specific for Commercial members with changed prior authorization periods for some drugs. Blenrep is a new policy, HCPCS code J9999 now requires prior authorization for it, and numerous injectables, including Botox, Opdivo SQ, Trastuzumab IV and Ocrevus IV, have revised policies effective 4/1/2026. Commercial knee brace codes L1834, L1840 and L1846 no longer require prior authorization because they are investigational, code 0707T now requires prior authorization under the Experimental and Investigational Procedures policy, and several Medicare Advantage medical policies were retired effective March 1, 2026.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 33 medical policy updates and revisions effective November 2025. Key changes include: new psychological/neuropsychological testing policy (CAM 397), extended lumbar fusion revision surgery timeline (9-12 months vs 6-12 months), expanded HIV testing coverage with PrEP criteria, negative pressure wound therapy trial period extended from 14 to 30 days, multiple CPT code additions/removals in sexual health and infectious disease testing, and new minimal residual disease coverage for diffuse large B-cell lymphoma. Billing teams must immediately update claim submission rules, prior authorization triggers, and CPT code billing matrices across multiple service lines.
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