Currentblue cross blue shield - arizonaPolicy N/A

Provider Office Laboratory Testing (POLT) List — allowable in-office laboratory CPT codes and operational rules

Governance of allowable in-office laboratory CPT codes for BCBSAZ Health Choice providers and notification of a POLT list update effective June 1, 2025; affects contracted providers and specified contracted labs.

Policy Summary

Payerblue cross blue shield - arizona

PolicyProvider Office Laboratory Testing (POLT) List — allowable in-office laboratory CPT codes and operational rules

Policy CodePolicy N/A

Change TypeAddition — CPT 87428

Effective DateJun 1, 2025

Next Review DateN/A

Key ActionEnsure use of contracted laboratories (LabCorp and Sonora Quest) when providing services to Health Choice members.

SourceLink

POLICY UPDATE CHANGES

CPT code 87428 was added to the Provider Office Laboratory Testing (POLT) List effective June 1, 2025.

2025-06-01POLT list effective date

1New CPT code added

2Contracted laboratory vendors

3+ pagesPOLT list length

POLT Coverage Criteria

Policy Summary

Payerblue cross blue shield - arizona

PolicyProvider Office Laboratory Testing (POLT) List — allowable in-office laboratory CPT codes and operational rules

Policy CodePolicy N/A

Change TypeAddition — CPT 87428

Effective DateJun 1, 2025

Next Review DateN/A

Key ActionEnsure use of contracted laboratories (LabCorp and Sonora Quest) when providing services to Health Choice members.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

POLT coverage criteria

Allowable in‑office laboratory services and operational rules:

Covered when ALL of the following are met:

Allowed CPT codes (examples)
- CPT 80305 — Drug test(s), presumptive, any number of drug classes, qualitative; includes sample validation when performed, per date of service.
- CPT 81000 — Urinalysis by dip stick or tablet reagent (bilirubin, glucose, hemoglobin, ketones).
- CPT 83036 — Hemoglobin; Glycosylated (A1C).
- CPT 87428 — Infectious agent antigens by immunoassay targeting SARS‑CoV/SARS‑CoV‑2 and influenza A/B (added effective June 1, 2025).
Services must be listed on the BCBSAZ Health Choice Provider Office Laboratory Testing (POLT) List (most current list available under 'Additional Resources and Guidelines' on the Health Choice provider sites).POLT list (see online resources)
Refer to the POLT List for the full enumerated list of CPT codes permitted for in‑office performance.
Providers must utilize contracted laboratories (LabCorp and Sonora Quest) for member services where applicable; note ACA StandardHealth with Health Choice is contracted only with Sonora Quest.
Use contracted vendors for member testing and referrals.
Consult the Prior Authorization Grid for any lab services that may require prior authorization.
Some lab services on or off the POLT list may require prior authorization.
POLT list updates and additions (for example, the addition of CPT 87428) are effective June 1, 2025 as communicated in the May 1, 2025 provider notice.
Effective date applies to codes added to the POLT list.

CPT Codes and POLT Scope

POLT allowed in-office CPT codes (sample)CPTCovered

80305	Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures capable of being read by direct optical observation only (e.g., dipstick, cups, cards, cartridges) includes sample validation when performed, per date of service (maps to 80300 or G0477).
81000	Urinalysis, By Dip Stick or Tablet Reagent; Bilirubin, Glucose, Hemoglobin, Ketones.
83036	Hemoglobin; Glycosylated (A1C).
87428	Infectious agent antigens through various immunoassay techniques, specifically targeting SARS‑CoV and SARS‑CoV‑2 and influenza A and B.

POLT list scope

Scope summaryEnumerates allowable in-office laboratory CPT codes that providers may perform (examples include 80305, 81000–81005, 81025, 82270, 82947–82948, 82962).

Effective datePOLT List update effective June 1, 2025 (provider notice dated May 1, 2025).

Network requirementProviders must utilize contracted laboratories (LabCorp and Sonora Quest) for member services; POLT designates specific services for in‑office performance.

List contentIncludes a range of urine and blood point‑of‑care and basic chemistry tests, urine pregnancy, occult blood, and glucose testing methods.

Source documentBCBSAZ Health Choice Approved Provider Office Lab Test List (effective June 1, 2025).

Provider Requirements and Reminders

Prior Authorization

Check the Prior Authorization Grid for lab approvals

Refer to the Prior Authorization Grid for any lab services that may require approval; the most up-to-date POLT list and provider resources (including the grid) are posted under 'Additional Resources and Guidelines' on the Health Choice provider sites.

Billing Rule

Use contracted labs (LabCorp and Sonora Quest)

Use contracted laboratories when providing services to Health Choice members; the Health Choice Provider Network includes LabCorp and Sonora Quest.

LabCorp: www.labcorp.com
Sonora Quest: www.sonoraquest.com

Key Definitions

Provider Office Laboratory Testing (POLT) List definition

DefinitionProvider Office Laboratory Testing (POLT) List — the payer‑approved list of CPT codes and in‑office laboratory services that may be performed by providers.

Most actionable itemCPT code 87428 was added to the POLT List and the updated list is effective June 1, 2025 — ensure billing and practice align with this change.

Implementation noteThe POLT List identifies specific CPT codes (examples in the list include 80305, 81000–81005, 81025, 82270, 82947–82948, 82962) that are permitted for in‑office performance by providers.

Network vendorsHealth Choice Provider Network includes LabCorp and Sonora Quest; providers should use contracted labs for member services when required.