CPT 87812 is referenced in 10 tracked payer policy changes from Anthem BCBS, BlueCross BlueShield of South Carolina, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 87812 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Effective January 1, 2027, HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid in Virginia) will discontinue reimbursement for 44 specific procedure codes to align with the Virginia Department of Medical Assistance Services (DMAS) fee schedule. The practice must stop billing these codes for dates of service on or after that date, as claims for discontinued codes will be denied or subject to adjustment and recovery.
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 35 updated medical policies effective January 2026, with the most critical changes being: (1) CPT code additions/deletions across multiple specialties effective 01/01/2026, (2) new investigational statements for Tibial Nerve Stimulation and Extracranial Carotid Artery Stenting, and (3) updated coverage denials for specific liver transplant indications. Most policies underwent annual reviews with no intent changes, but coding section updates require immediate billing system modifications.
Independence Blue Cross updated laboratory services policy MA00.030aj to MA00.030am, effective 01/01/2026, adding 18 new CPT/HCPCS codes to the capitated laboratory program and removing 8 terminated codes. One procedure code (87812) was added to non-capitated hospital laboratory services. Billing teams must update systems to route claims for new codes to designated capitated laboratory sites and verify code status before processing claims.
Independence Blue Cross updated Medicare Advantage policy MA00.010av to MA00.010aw effective 01/01/2026, adding 39 new CPT/HCPCS codes across DME, laboratory, and radiology services, revising narratives for 8 existing codes, and terminating 23 codes. Billing teams must update systems to reflect these code additions, deletions, and narrative changes to ensure accurate reimbursement for PPO members.
Independence Blue Cross updated policy 00.03.07ar to 00.03.07au effective 01/01/2026, adding 18 new CPT/HCPCS laboratory codes to the capitated laboratory program (Attachment A1) and removing 8 terminated codes, plus adding CPT 87812 to non-capitated outpatient hospital laboratory services (Attachment B2). Billing teams must update systems to route the newly added codes to designated capitated lab sites for HMO/HMO-POS members and ensure CPT 87812 is only billed to outpatient hospital labs under specific circumstances.
FDA-approved COVID-19 antigen diagnostic testing using a nasopharyngeal or nasal swab is medically appropriate within the first five days of symptom onset for individuals suspected of COVID-19 by their healthcare provider. COVID-19 antigen testing not approved by the FDA, including any test authorized under an EUA, is considered investigational, and FDA-approved testing is considered not medically necessary if performed more than five days after symptom onset. Screening of asymptomatic individuals is considered not medically necessary, including testing to rule out COVID-19 infection, testing for immunity, screenings to return to work and screenings to resume traveling, and CPT 87812 was added on 01/01/2026.
BlueCross BlueShield of South Carolina updated 34 medical policies effective January 1, 2026, primarily involving annual reviews and CPT code changes. Multiple policies added new codes while deleting outdated ones, with most changes having no impact on coverage intent.
Independence Blue Cross updated policy MA00.033r to MA00.033s effective January 1, 2026, adding five new CPT/HCPCS codes (A4295, A4296, A4297, 87812, 90481) eligible for payment above capitation to HMO/HMO-POS primary care providers in Pennsylvania and New Jersey, and revising narrative descriptions for codes A4351, A4352, and 10040. Billing teams must update systems to recognize these newly eligible codes for above-capitation reimbursement.
Independence Blue Cross updated policy 00.10.01am (now 00.10.01an) to reflect CPT/HCPCS code changes effective 01/01/2026. Five new codes (A4295, A4296, A4297, 87812, 90481) were added to Attachments A and B for services paid above capitation to HMO/HMO-POS primary care providers in PA and NJ. Two codes (A4351, A4352) underwent narrative revisions in both attachments, and two additional codes (10040, A4351, A4352) had revisions in Attachment B.
Effective for dates of service on or after January 1, 2026, Indiana Medicaid lists the new CPT, CDT and other HCPCS codes from the 2026 annual HCPCS update as either covered or noncovered, and shows whether each one requires prior authorization or NDC. Codes discontinued in the update are listed with alternate code considerations, and the source states that inclusion of an alternate code does not indicate IHCP coverage of that alternate code. The IHCP is awaiting the final posting of the CMS fee schedules that set pricing for these codes, and reimbursement amounts will be posted on the Professional Fee Schedule and Outpatient Fee Schedule once pricing is established.
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