Provider Office Laboratory Testing (POLT) List — Updated POLT List Effective June 1, 2025
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Defines the list of in-office laboratory CPT codes approved for performance by contracted providers in the BCBSAZ Health Choice network and notes contracted labs; affects network providers performing office-based lab testing.
CPT code 87428 was added to the Provider Office Laboratory Testing (POLT) List effective June 1, 2025.
Approved In-Office Laboratory Tests (POLT List)
Approved in-office tests
Covered when performed in-office by contracted providers in the BCBSAZ Health Choice network as listed on the Provider Office Laboratory Testing (POLT) List effective June 1, 2025.
ALL of the following
Examples of approved in-office POLT CPT codes
- CPT 80305 — Drug test(s), presumptive, any number of drug classes, qualitative; direct optical observation devices (e.g., dipstick, cups, cards, cartridges).
- CPT 81000 — Urinalysis by dip stick or tablet reagent (Bilirubin, Glucose, Hemoglobin, Ketones).
- CPT 83036 — Hemoglobin A1c (glycosylated hemoglobin).
- CPT 87428 — Infectious agent antigen detection by immunoassay targeting SARS coronaviruses and influenza A and B.
- CPT 85610 — Prothrombin Time.
ALL of the following
- Providers must use contracted laboratories where required by network agreements; see provider guidance for LabCorp and Sonora Quest listings and network-specific vendor details.
- Refer to the full POLT List on the payer website for the complete set of allowable in-office CPT codes and any updates (the POLT List was updated effective June 1, 2025, and included addition of CPT 87428).
POLT CPT Codes and Coding Notes
| 87428 | Infectious agent antigens through various immunoassay techniques, specifically targeting severe acute respiratory syndrome coronaviruses, including SARS-CoV and SARS-CoV-2, as well as influenza virus types A and B. |
| 80305 | Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, (e.g., immunoassay) 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). |
| 85610 | Prothrombin Time. |
Provider Responsibilities and Billing Reminders
Prior Authorization Reminder — check the Prior Authorization Grid
Be sure to check the Prior Authorization Grid before ordering laboratory services to determine if prior approval is required for the test(s). Failure to obtain required prior authorization may result in claim denial or delayed payment.
- Refer to 'Additional Resources and Guidelines' on the Health Choice provider sites for the POLT List and Prior Authorization Grid: https://www.healthchoiceaz.com/; https://www.azblue.com/health-choice-pathway; https://www.azblue.com/acastandardhealth-health-choice
Use Contracted Laboratories (LabCorp and Sonora Quest)
Providers must use contracted laboratories (LabCorp and Sonora Quest) when providing laboratory services to Health Choice members unless a specific exception is documented. The Health Choice Provider Network includes both LabCorp and Sonora Quest Laboratories for in-office, reference, and specialty testing. See the POLT List for services designated for in-office performance by providers.
- Contracted labs: LabCorp (www.labcorp.com)
- Contracted labs: Sonora Quest (www.sonoraquest.com)
- POLT List addition effective 2025-06-01: CPT 87428 — consult POLT for in-office designations
Key Definitions
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