Does Anthem BCBS require prior authorization for 87652?

Anthem BCBS lists 87652 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 87652?

Florida Blue lists 87652 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 87652?

There are 4 tracked policy changes affecting CPT 87652, 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 87652?

Payers that have issued tracked updates for CPT 87652 include: Regence BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 87652 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 87652. 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 87652?

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

87652 Insurance Policy Changes

CPT 87652 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 87652 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 8, 2026Medium impact
Pneumococcal Vaccines (CPB 0037, reviewed 2026-10-06)
Aetna considers FDA-approved pneumococcal conjugate vaccines (PCV15, PCV20, PCV21) and pneumococcal polysaccharide vaccine (PPSV23) medically necessary according to CDC ACIP recommendations for specified groups. Those groups include all children aged 2 through 59 months, children and adolescents who meet the listed risk-condition and catch-up criteria, adults 50 years of age or older who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown, and adults 19 through 49 years with listed underlying health conditions. Adults 65 years or older may receive PCV20 or PCV21 through shared clinical decision-making, or receive no additional pneumococcal vaccines. Aetna considers these vaccines experimental, investigational or unproven for other groups. Quantitation of Streptococcus pneumoniae antibody (IgG) is medically necessary to diagnose immunodeficiency syndromes in persons with recurrent bacterial infections and to assess eligibility for parenteral immunoglobulin replacement, and is experimental, investigational or unproven for other indications.
Aetna · Identified Aug 13, 2026Medium impact
Pneumococcal Vaccines (CPB 0037, reviewed 2026-03-02)
Aetna's pneumococcal vaccine policy considers the conjugate vaccines PCV15 (Vaxneuvance), PCV20 (Prevnar 20) and PCV21 (Capvaxive) medically necessary for the age and risk groups it lists, and PPSV23 (Pneumovax 23) for the groups in its selection criteria. Coverage follows the CDC's ACIP recommendations, including the dosing rules for children, adults 19 to 49 years with underlying conditions, and adults 50 years or older. Aetna considers these vaccines experimental, investigational or unproven for other groups, and considers quantitation of Streptococcus pneumoniae IgG antibody medically necessary only to diagnose immunodeficiency in persons with recurrent bacterial infections and to assess eligibility for parenteral immunoglobulin replacement.
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

Pneumococcal Vaccines (CPB 0037, reviewed 2026-10-06)

Pneumococcal Vaccines (CPB 0037, reviewed 2026-03-02)