Feb. 25, 2025
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 policy was updated:
- CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) policy was updated Effective May 15, 2025
The following lab management policies were updated:
- CPCPLAB001 Flow Cytometry, effective May 15, 2025
- CPCPLAB002 Cervical Cancer Screening, effective May 15, 2025
- CPCPLAB003 Vitamin D, effective May 15, 2025
- CPCPLAB004 Diabetes Mellitus Testing, effective May 15, 2025
- CPCPLAB008 Diagnostic Testing of Iron, effective May 15, 2025
- CPCPLAB010 Vitamin B12 and Methylmalonic Acid Testing, effective May 15, 2025
- CPCPLAB011 Biomarker Testing for Autoimmune Rheumatic Disease, effective May 15, 2025
- CPCPLAB014 Prenatal Screening Nongenetic, effective May 15, 2025
- CPCPLAB015 Hepatitis Testing, effective May 15, 2025
- CPCPLAB018 Helicobacter pylori Testing, effective May 15, 2025
- CPCPLAB019 Thyroid Disease Testing, effective May 15, 2025
- CPCPLAB020 Cardiovascular Disease Risk Assessment, effective May 15, 2025
- CPCPLAB025 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and FMT Testing , effective May 15, 2025
- CPCPLAB026 Fecal Calprotectin Testing in Adults, effective May 15, 2025
- CPCPLAB027 Testing for Diagnosis of Active or Latent Tuberculosis, effective May 15, 2025
- CPCPLAB030 In Vitro Chemoresistance and Chemosensitivity Assays, effective May 15, 2025
- CPCPLAB032 Oral Cancer Screening and Testing, effective May 15, 2025
- CPCPLAB035 Laboratory Testing for the Diagnosis of IBD, effective May 15, 2025
- CPCPLAB036 Serum Biomarker Testing for MS, effective May 15, 2025
- CPCPLAB037 Serum Tumor Markers for Malignancies, effective May 15, 2025
- CPCPLAB038 Urinary Tumor Markers for Bladder Cancer, effective May 15, 2025
- CPCPLAB045 Pathogen Panel Testing, effective May 15, 2025
- CPCPLAB047 Pancreatic Enzyme Testing for Acute Pancreatitis, effective May 15, 2025
- CPCPLAB049 General Inflammation Testing, effective May 15, 2025
- CPCPLAB052 Testing for Vector-Borne Infections, effective May 15, 2025
- CPCPLAB053 B-Hemolytic Streptococcus Testing, effective May 15, 2025
- CPCPLAB056 Gamma-glutamyl Transferase, effective May 15, 2025
- CPCPLAB057 Coronavirus Testing in the Outpatient Setting, effective May 15, 2025
- CPCPLAB058 Venous and Arterial Thrombosis Risk Testing, effective May 15, 2025
- CPCPLAB061 Testing for Alpha-1 Antitrypsin Deficiency, effective May 15, 2025
- CPCPLAB063 Identification of Microorganisms, effective May 15, 2025
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Clinical payment and coding policies are based on using healthcare professionals and industry standard guidelines. The clinical payment and coding guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.