Reminder: Reimbursement for Multiple Individual Labs

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) reimburses codes for multiple individual labs using the most comprehensive procedure code.

As a reminder, our bundling policy states: 

When all components are performed on the same date of service and are billed together, services are recoded into the more comprehensive procedure. 
 
Please see the example below: 

Applicable single STI CPT codes:

• 87491: Infectious agent detection by nucleic acid (DNA or RNA); chlamydia trachomatis, amplified probe technique
• 87591: Infectious agent detection by nucleic acid (DNA or RNA); neisseria gonorrhoeae, amplified probe technique
• 87661: Infectious agent detection by nucleic acid (DNA or RNA); trichomonas vaginalis, amplified probe technique

Applicable, more appropriate and comprehensive multiple organism code:

• 87801: Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique 

Blue Cross NC will reimburse the more comprehensive, multiple organism code for infectious agent detection by nucleic acid, amplified probe technique (CPT code 87801), when two or more single test CPT codes are billed separately by the same provider on the same date of service. Reimbursement will be made based on a single unit of CPT code 87801 regardless of the units billed for a single code. No modifiers will override the edit. 

This stance of recoding and/or reimbursing to the most comprehensive code applies to Commercial, Inter-Plan Program (IPP) Host, State Health Plan, Medicare Advantage, and Federal Employee Program (FEP). This does not apply to IPP Home.