CPT 89280 is referenced in 4 tracked payer policy changes from Sentara Health Plans, Blue Cross NC, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 89280 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Blue Cross NC updated 40+ commercial medical policies on April 15, 2026, with most changes being administrative updates to descriptions, references, and guidelines. Key billing changes include removal of numerous fertility treatment codes from coverage and addition of specific billing guidance for sleep apnea devices using code E0486.
Healthfirst covers infertility and fertility preservation services based on the member's benefit plan, and coverage differs by line of business. Essential Plan and Qualified Health Plan members receive basic infertility treatment, including prescription drugs, and Medicaid Managed Care and HARP infertility benefits are limited to three treatment cycles per lifetime. Excluded services include in vitro fertilization, gamete and zygote intrafallopian transfer, donor ova and sperm costs, embryo cryopreservation, reversal of tubal ligation or vasectomy, and surrogacy costs.
Aetna's Clinical Policy Bulletin 0358 considers invasive prenatal diagnosis by chorionic villus sampling (CVS), genetic amniocentesis, and percutaneous umbilical blood sampling (PUBS, cordocentesis) medically necessary for diagnosing fetal chromosomal abnormalities. Preimplantation genetic testing for monogenic disorders (PGT-M) is medically necessary only when the listed criteria are met, including a known carrier parent for the specific indication, a specific identified mutation, and a procedure that eliminates the need for later invasive prenatal diagnosis. PGT-A, PGT-M for fetal chromosomal abnormalities, PGT-M to determine HLA status for stem cell donation, multigene panels at PGT-M testing, and invasive screening or PGT for a variant of uncertain significance are considered experimental, investigational, or unproven, as are the Igenomix PGT-M, PGT-SR, Smart PGT-A and Smart PGT-A Plus tests, the IriSight Prenatal Analysis, and the Natera Spectrum PGT-M test.
Watch 89280
Get one email when a payer policy names 89280, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
See every payer rule for 89280
Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 89280 in one place.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.