Does Anthem BCBS require prior authorization for 87495?

Anthem BCBS lists 87495 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 Florida Blue require prior authorization for 87495?

Florida Blue lists 87495 on Prior Authorization List: HMO – Marketplace Qualified Health Plans for exchange plans (list dated March 27, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 87495?

There are 3 tracked policy changes affecting CPT 87495, including updates from Regence BlueShield, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 87495?

Payers that have issued tracked updates for CPT 87495 include: Regence BlueShield, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 87495 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 87495. 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 87495?

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

87495 Insurance Policy Changes

CPT 87495 is referenced in 3 tracked payer policy changes from Regence BlueShield and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 87495 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Regence BlueShield · Effective Oct 1, 2026Medium impact
Identification of Microorganisms Using Nucleic Acid Probes
Effective October 1, 2026, nucleic acid probe testing with or without quantification may be considered medically necessary for BK virus, cytomegalovirus, hepatitis B, hepatitis C, hepatitis D, HIV-1, HIV-2, human herpesvirus 6 and influenza virus. Respiratory pathogen panels with 12 or more targets are considered not medically necessary. Quantification for other microorganisms, hepatitis G testing, central nervous system pathogen panels, urinary tract infection panels, joint infection panels, endometrial pathogen panels, pathogen panels for surgical or chronic wounds and oral HPV testing are considered investigational.
Regence BlueShield · Effective Oct 1, 2026Medium impact
Identification of Microorganisms Using Nucleic Acid Probes
Medical Policy GT85, Identification of Microorganisms Using Nucleic Acid Probes, is effective October 1, 2026. Nucleic acid testing using a direct or amplified probe technique, with or without quantification, may be considered medically necessary for BK virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, hepatitis D virus, HIV-1, HIV-2, human herpesvirus 6, and influenza virus. Respiratory pathogen panels with 12 or more targets are considered not medically necessary. Testing with quantification or semi-quantification for other microorganisms, hepatitis G virus testing, central nervous system pathogen panels, urinary tract infection pathogen panels, joint infection panels, endometrial pathogen panels, pathogen panels for surgical or chronic wounds, and oral HPV testing are considered investigational. The technique for quantification includes both amplification and direct probes, so simultaneous coding for quantification with either amplification or direct probes is not warranted. SARS-CoV-2 nucleic acid testing is addressed in a separate policy, COVID-19 Testing, Laboratory, Policy No. 74.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Identification of Microorganisms Using Nucleic Acid Probes
Nucleic acid probe testing without quantification of viral load may be considered medically necessary for listed organisms including Bartonella henselae and quintana, Bordetella pertussis, Candida species, Chlamydia, Clostridium difficile, Herpes simplex virus, influenza virus, Mycobacterium tuberculosis, Neisseria gonorrhoeae, Streptococcus group A and group B, Trichomonas vaginalis and Zika virus. Probe testing with or without quantification may be considered medically necessary for cytomegalovirus, hepatitis B and C, HIV-1, HIV-2 and human herpes virus 6, and quantification is investigational for organisms not on that list. Nucleic acid testing with a direct or amplified probe for Gardnerella vaginalis and Hepatitis G is considered investigational, and pathogen panel testing is addressed in the Pathogen Panel Testing medical policy.

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Identification of Microorganisms Using Nucleic Acid Probes

Identification of Microorganisms Using Nucleic Acid Probes

Identification of Microorganisms Using Nucleic Acid Probes

Prior authorization required in some cases

Prior authorization required

Does Anthem BCBS require prior authorization for 87495?

Does Florida Blue require prior authorization for 87495?

What insurance policy changes affect CPT 87495?

Which payers have updated policy for CPT 87495?

How do I get notified when CPT 87495 policy changes?

Why do payers change policies for CPT 87495?