Does Anthem BCBS require prior authorization for 87512?

Anthem BCBS lists 87512 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 CalViva Health require prior authorization for 87512?

CalViva Health lists 87512 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 87512?

Community Health Plan of Imperial Valley lists 87512 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Florida Blue require prior authorization for 87512?

Florida Blue lists 87512 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 87512?

There are 4 tracked policy changes affecting CPT 87512, including updates from Regence BlueShield, Aetna, 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 87512?

Payers that have issued tracked updates for CPT 87512 include: Regence BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 87512 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 87512. 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 87512?

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

87512 Insurance Policy Changes

CPT 87512 is referenced in 4 tracked payer policy changes from Regence BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 87512 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
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.
Aetna · Identified Oct 1, 2026Medium impact
Diagnosis of Vaginitis (CPB 0643, reviewed 2026-09-25)
Aetna's vaginitis diagnosis policy (CPB 0643), last reviewed 09/25/2026, considers nucleic acid amplification or DNA probe tests for trichomonas, Candida and Gardnerella medically necessary for members with dysuria or symptoms of vaginitis. It also considers BVBlue sialidase testing, PCR tests for bacterial vaginosis and Candida, and pH and amine testing medically necessary for women with symptoms. Trichomonas screening is considered medically necessary for women with listed risk factors, including HIV-positive women, new or multiple partners, history of sexually transmitted diseases, exchange of sex for payment, injection drug use, or high-prevalence settings. Routine screening of asymptomatic women for Candida and Gardnerella, Pap smears for the diagnosis of Candida vulvovaginitis, the uBiome SmartJane screen and the 27-organism vaginal pathogen panel are experimental, investigational or unproven, and screening asymptomatic pregnant women for bacterial vaginosis is experimental and not covered.
Aetna · Identified Aug 14, 2026Medium impact
Diagnosis of Vaginitis (CPB 0643, reviewed 2025-12-15)
Aetna considers several vaginitis tests medically necessary for women with symptoms of vaginitis, including nucleic acid amplification or DNA probe assays for trichomonas, Candida and Gardnerella for members with dysuria or symptoms of vaginitis, sialidase activity testing such as the BVBlue test, and pH and amine testing of vaginal fluid. Screening for Trichomonas vaginalis is considered medically necessary for women with risk factors such as HIV-positive status, new or multiple partners, a history of sexually transmitted diseases, exchange of sex for payment, injection drug use, or high-prevalence settings such as STD clinics and correctional facilities. A Pap smear for the diagnosis of Candida vulvo-vaginitis, routine screening for Candida and Gardnerella in asymptomatic women, the uBiome SmartJane screen, and the 27-organism vaginal pathogen panel from Bridge Diagnostics are considered experimental, investigational, or unproven because their effectiveness has not been established.
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

Diagnosis of Vaginitis (CPB 0643, reviewed 2026-09-25)

Diagnosis of Vaginitis (CPB 0643, reviewed 2025-12-15)