Clinical Payment and Coding Policy Updates

Dec. 9, 2024

Clinical Payment and Coding Policies  describe payment rules and methodologies for Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies. It’s not intended to address all reimbursement-related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process.  

The following policies were updated:  

  • CPCP008: Psychological and Neuropsychological Testing – Effective 11/18/24
  • CPCP020: Drug Testing – Effective 11/18/24
  • CPCP029: Medical Record Documentation – Effective 11/18/24
  • CPCP036: Paravertebral Facet Injection Procedure Coding & Billing Policy – Effective 11/18/24
  • CPCPLAB001: Flow Cytometry Disease – Effective 1/15/25
  • CPCPLAB002: Cervical Cancer Screening – Effective 1/15/25
  • CPCPLAB005: Prostate Biopsies – Effective 1/15/25
  • CPCPLAB011: Biomarker Testing for Autoimmune Rheumatic Disease – Effective 1/15/25
  • CPCPLAB014: Prenatal Screening (Nongenetic) – Effective 1/15/25
  • CPCPLAB015: Hepatitis Testing – Effective 1/15/25
  • CPCPLAB017: Celiac Disease Testing – Effective 1/15/25
  • CPCPLAB019: Thyroid Disease Testing – Effective 1/15/25
  • CPCPLAB020: Cardiovascular Disease Risk Assessment – Effective 1/15/25
  • CPCPLAB022: Prenatal Screening for Fetal Aneuploidy – Archived Effective 10/31/23 
  • CPCPLAB024: Epithelial Cell Cytology in Breast Cancer Risk Assessment – Effective 1/15/25
  • CPCPLAB025: Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing – Effective 1/15/25
  • CPCPLAB026: Fecal Calprotectin Testing – Effective 1/15/25
  • CPCPLAB027: Testing for Diagnosis of Active or Latent Tuberculosis – Effective 1/15/25
  • CPCPLAB030: In Vitro Chemoresistance and Chemosensitivities Assays – Effective 1/15/25
  • CPCPLAB031: Measurement of Thromboxane Metabolites for ASA Resistance – Archived Effective 10/31/23 
  • CPCPLAB032: Oral Cancer Screening and Testing – Effective 1/15/25
  • CPCPLAB033: Diagnostic Testing of Influenza – Effective 1/15/25
  • CPCPLAB034: Salivary Hormone Testing – Effective 1/15/25
  • CPCPLAB035: Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease – Effective 1/15/25
  • CPCPLAB036: Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases – Effective 1/15/25
  • CPCPLAB037: Serum Tumor Markers for Malignancies – Effective 1/15/25
  • CPCPLAB038: Urinary Tumor Markers for Bladder Cancer – Effective 1/15/25
  • CPCPLAB045: Pathogen Panel Testing – Effective 1/15/25
  • CPCPLAB046: Biomarkers for Myocardial Infarction and Chronic Heart Failure – Effective 1/15/25
  • CPCPLAB047: Pancreatic Enzyme Testing for Acute Pancreatitis – Effective 1/15/25
  • CPCPLAB048: Folate Testing– Effective 1/15/25
  • CPCPLAB049: General Inflammation Testing – Effective 1/15/25
  • CPCPLAB050: Urine Culture Testing for Bacteria – Effective 1/15/25
  • CPCPLAB051: Diagnostic Testing of Common Sexually Transmitted Infections – Effective 1/15/25
  • CPCPLAB052: Testing for Vector-Borne Infections – Effective 1/15/25
  • CPCPLAB053: Lab Hemolytic Streptococcus Testing – Effective 1/15/25
  • CPCPLAB056: Gamma-glutamyl Transferase – Effective 1/15/25
  • CPCPLAB058: Venous and Arterial Thrombosis Risk Testing – Effective 1/15/25
  • CPCPLAB061: Testing for Alpha-1 Antitrypsin Deficiency – Effective 1/15/25
  • CPCPLAB063: Identification of Microorganisms using Nucleic Acid Probes – Effective 1/15/25
  • CPCPLAB064: Nerve Fiber Density Testing – Effective 1/15/25
  • CPCPLAB066: DNA Ploidy Cell Cycle Analysis – Archived Effective 1/31/23
  • CPCPLAB070: Colorectal Cancer Screening – Effective 1/15/25