CurrentBlue Cross Blue Shield - IllinoisPolicy CPCPLAB048

Folate Testing

This policy defines when serum and RBC folate tests and folate receptor autoantibody testing are reimbursable under Blue Cross Blue Shield of Illinois and describes related coding guidance; it applies to providers submitting claims to BCBSIL plans.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyFolate Testing

Policy CodePolicy CPCPLAB048

Change TypeNo material changes

Effective DateSep 5, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to coding and coverage review.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3reimbursable indications

Not reimbursableRBC folate

Not reimbursableFolate receptor antibody

3codes listed

CPCPLAB048document id

Folate Testing Coverage Criteria

Folate testing coverage criteria

Reimbursement rules for folate testing:

ALL of the following

ONE of
- Measurement of serum folate concentration for individuals with megaloblastic or macrocytic anemia.
- Measurement of serum folate concentration for individuals who have undergone, or who have been scheduled for, bariatric procedures (e.g., Roux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion/duodenal switch).
Measurement of serum folate concentration for any other indications is NOT reimbursable.
Applies when none of the reimbursable indications above are present.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyFolate Testing

Policy CodePolicy CPCPLAB048

Change TypeNo material changes

Effective DateSep 5, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to coding and coverage review.

SourceLink

On This Page

Procedure Codes and Coding Notes

Codes mentioned in policyCPT | mixed

82746	Folate; serum
82747	Folate; red blood cell (listed but policy states RBC folate not reimbursable)
0399U	Folate receptor autoantibody (proprietary/unlisted molecular)

Code inclusion note

Scope of code listThe listed procedure codes are not all‑encompassing; other relevant codes may exist.

No guarantee of coverageInclusion of a code in the list does not guarantee it is a covered service or eligible for reimbursement.

Reference for coding detailsSee Plan documents and coding guidance for product‑specific coverage and reimbursement determinations.

Documentation and Claim Review Expectations

Documentation Required

Documentation, coding, and claim review expectations

Providers must submit accurate documentation of services performed, code claims using valid HIPAA-approved code sets, and code appropriately per industry-standard coding guidelines. Claims are subject to code edit protocols and review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. Upon request, providers must submit any additional documentation. If a conflict exists between this policy and a plan document or provider contract, the plan document or provider contract will govern.

Submit accurate documentation of services performed and use valid HIPAA-approved code combinations.
Code claims according to industry-standard guidelines (e.g., UB, AMA CPT, HCPCS, ICD-10, NDC, DRG, CMS NCCI).
Claims may be reviewed for coding edits, benefit coverage, contract terms, medical policies, and coding software logic.
Provide additional documentation upon request.
Plan documents or provider contracts govern in the event of a conflict with this policy.

Plan Criteria and Definitions

Plan criteria — Lab management reimbursement criteria

PurposeLab management reimbursement criteria define when folate‑related tests may be reimbursable under the Plan.

Reimbursable serum folate indicationsMeasurement of serum folate may be reimbursable for individuals with megaloblastic or macrocytic anemia and for individuals who have undergone or are scheduled for bariatric procedures (Roux‑en‑Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion/duodenal switch).

Not reimbursable — serum for other indicationsMeasurement of serum folate for indications other than those listed above is not reimbursable.

Not reimbursable — RBC folateMeasurement of red blood cell (RBC) folate is not reimbursable for all indications.

Not reimbursable — folate receptor autoantibodyFolate receptor autoantibody testing is not reimbursable for all situations.