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S3870

PAYER POLICY CHANGES

S3870 Insurance Policy Changes

HCPCS S3870 is officially defined as "Comparative genomic hybridization (cgh) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disability." HCPCS S3870 is referenced in 5 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS S3870 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Nov 20, 2025Medium impact
Chromosomal Microarray (CMA) Analysis for Prenatal Evaluation and Evaluation of Patients with Developmental Delay/ Intellectual Disability or Autism Spectrum Disorder 2.02.42
Excellus BlueCross BlueShield policy 2.02.42 covers chromosomal microarray analysis (CMA) for children with apparent nonsyndromic developmental delay or intellectual disability, autism spectrum disorder, or multiple anomalies not specific to a well-delineated genetic syndrome, and for pregnant patients undergoing invasive prenatal diagnostic testing. The 11/20/25 annual review removed the policy criteria for FMR1 gene analysis and the criterion that genetic test results have the potential to impact clinical management. The current effective date is November 20, 2025, and CMA used to confirm a disorder that is routinely diagnosed on clinical evaluation alone is considered not medically necessary.
Aetna · Identified Oct 23, 2026Medium impact
Autism Spectrum Disorders (CPB 0648, reviewed 2026-10-20)
Aetna considers autism spectrum disorder (ASD) evaluation and diagnosis medically necessary when developmental delays or persistent deficits in social communication and social interaction across multiple contexts have been identified and the evaluation is performed by an appropriate certified or licensed health care professional. The following services may be included in the assessment and treatment of ASD: ASD-specific developmental evaluation, cognitive and adaptive behavior evaluations, speech-language evaluation, formal audiological hearing evaluation, genetic testing within stated criteria, medical evaluation, and pharmacotherapy for co-morbidities subject to the member's drug benefits. The policy lists many assessments and treatments as experimental, investigational, or unproven, including the EarliPoint eye-tracking test, metabolomic blood tests, chelation therapy, and hyperbaric oxygen therapy, and it states that services primarily educational in nature are not covered under medical benefits.
Aetna · Identified Aug 19, 2026Medium impact
Comparative Genomic Hybridization (CGH) (CPB 0787, reviewed 2025-11-19)
Aetna considers comparative genomic hybridization (CGH), also called chromosomal microarray analysis, medically necessary for fetal structural abnormalities detected on fetal ultrasound or fetal MRI, for histologically equivocal Spitzoid melanocytic neoplasms, for initial evaluation of myelodysplastic syndrome when standard cytogenetics cannot be obtained or the karyotype is normal, for pregnant women undergoing invasive prenatal diagnostic testing for any indication, and for fetal tissue analysis in intrauterine fetal death or stillbirth at 20 weeks gestation or greater. Aetna also considers CGH medically necessary for diagnosing genetic abnormalities in children with congenital anomalies, or with intellectual disability, developmental delay or autism spectrum disorder, when the listed criteria are met. CGH is not considered medically necessary when a disorder or syndrome is readily apparent based on clinical evaluation alone, and only one CGH per lifetime is considered medically necessary. Aetna considers CGH experimental, investigational or unproven for indications including detection of balanced rearrangements, diagnosis of melanoma, diagnosis of neurodevelopmental delays, evaluation of primary ovarian insufficiency, evaluation of short stature, evaluation of unexplained epilepsies, evaluation of autoimmune lymphoproliferative syndrome, evaluation of craniosynostosis, and genetic abnormalities in individuals over 18 years of age with congenital anomalies or with autism spectrum disorder or intellectual disability.
Aetna · Identified Aug 12, 2026Medium impact
Autism Spectrum Disorders (CPB 0648, reviewed 2025-10-02)
Aetna Clinical Policy Bulletin 0648 covers evaluation and treatment of autism spectrum disorder (ASD). ASD evaluation and diagnosis is considered medically necessary when developmental delays or persistent deficits in social communication and social interaction across multiple contexts have been identified and the evaluation is performed by an appropriate certified or licensed health care professional. The services that may be included in assessment and treatment are ASD-specific developmental evaluation, cognitive and adaptive behavior evaluations, speech and language evaluation by a speech-language pathologist, formal audiological hearing evaluation, medical evaluation, and selected genetic and metabolic testing when criteria are met. Intensive educational interventions, pharmacotherapy for co-morbidities, behavior modification for behavioral co-morbidities, and physical and occupational therapy for co-morbid physical impairments may also be included. The policy lists numerous tests and treatments as experimental, investigational, or unproven for ASD.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies
Chromosomal microarray (CMA) testing may be considered medically necessary as first-line testing in the initial evaluation of individuals with apparent nonsyndromic developmental delay or intellectual disability, autism spectrum disorder, or multiple congenital anomalies not specific to a well-delineated genetic syndrome. CMA is considered investigational for all other conditions of delayed development, including idiopathic growth or language delay. Panel testing using next-generation sequencing is considered investigational in all cases of suspected genetic abnormality in children with developmental delay or intellectual disability, autism spectrum disorder, or congenital anomalies, and CMA testing is not intended for use in the prenatal period.

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REFERENCE DATA

Payers with rules14

Payers requiring prior auth14

Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
BCBS Arizona · Effective October 1, 2026
Prior authorization required in some cases
AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026)
CountyCare Health Plan · Effective April 23, 2026
Prior authorization required
CountyCare Prior Authorization Look-Up Tool (All Codes)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for S3870?

Ambetter lists S3870 on Ambetter Health of Delaware CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for S3870?

AmeriHealth Caritas lists S3870 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for S3870?

Anthem BCBS lists S3870 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for S3870?

BCBS Arizona lists S3870 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for S3870?

BCBS Illinois lists S3870 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS S3870?

There are 5 tracked policy changes affecting HCPCS S3870, including updates from Excellus BlueCross 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 HCPCS S3870?

Payers that have issued tracked updates for HCPCS S3870 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when HCPCS S3870 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS S3870. 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 HCPCS S3870?

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.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for S3870 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Chromosomal Microarray (CMA) Analysis for Prenatal Evaluation and Evaluation of Patients with Developmental Delay/ Intellectual Disability or Autism Spectrum Disorder 2.02.42

Autism Spectrum Disorders (CPB 0648, reviewed 2026-10-20)

Comparative Genomic Hybridization (CGH) (CPB 0787, reviewed 2025-11-19)

Autism Spectrum Disorders (CPB 0648, reviewed 2025-10-02)

Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies

Prior authorization required

Prior authorization required in some cases