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PAYER POLICY CHANGES

88291 Insurance Policy Changes

CPT 88291, in plain terms, covers A detailed analysis report combining information from cell samples with molecular testing results to diagnose disease. CPT 88291 is referenced in 2 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 88291 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 88291 on AAPC

Watch 88291

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REFERENCE DATA

Payers with rules9
Payers requiring prior auth9
  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

  • Anthem BCBS · Effective September 1, 2026

    Prior authorization required in some cases

    Virginia Local Precertification/Prior Authorization List (HMO & EPO)

  • Florida Blue · Effective March 27, 2026

    Prior authorization required

    Prior Authorization List: HMO – Marketplace Qualified Health Plans

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 88291?

Ambetter lists 88291 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 88291?

Anthem BCBS lists 88291 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 BCBS Michigan require prior authorization for 88291?

BCBS Michigan lists 88291 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 88291?

CalViva Health lists 88291 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 Carolina Complete Health require prior authorization for 88291?

Carolina Complete Health lists 88291 on Carolina Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 88291?

There are 2 tracked policy changes affecting CPT 88291, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 88291?

Payers that have issued tracked updates for CPT 88291 include: Aetna.

How do I get notified when CPT 88291 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 88291. 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 88291?

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.

See every payer rule for 88291

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 88291 in one place.

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