CurrentBlue Cross Blue Shield - IllinoisPolicy CPCPLAB030

In Vitro Chemoresistance and Chemosensitivity Assays

Defines Blue Cross Blue Shield of Illinois reimbursement stance for in vitro chemosensitivity and chemoresistance laboratory assays and lists related procedure codes; applies to providers submitting claims to BCBSIL.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyIn Vitro Chemoresistance and Chemosensitivity Assays

Policy CodePolicy CPCPLAB030

Change TypeNew policy

Effective DateJan 1, 2026

Next Review Date

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

SourceLink

POLICY UPDATE CHANGES

New policy established declaring in vitro chemosensitivity and chemoresistance assays non-reimbursable.

2non-reimbursable assay types

15listed procedure/U-codes

2026-01-01plan effective

09/25/2025approval date

Coverage Criteria

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyIn Vitro Chemoresistance and Chemosensitivity Assays

Policy CodePolicy CPCPLAB030

Change TypeNew policy

Effective DateJan 1, 2026

Next Review Date

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

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.

ALL of the following

In vitro chemosensitivity assays (e.g., histoculture drug response assay, fluorescent cytoprint assay) are not reimbursable.
Applies to all products unless overridden by specific plan documents.
In vitro chemoresistance assays (e.g., extreme drug resistance [EDR] assays) are not reimbursable.
Applies to all products unless overridden by specific plan documents.

Exceptions: No exceptions specified in this policy text.

Codes and Coding Notes

Listed procedure and U-codesmixedNot Covered

81535
81536
86849
88104
88199
88305
88313
88358
89050
89240

1–10 of 16

1/2

Coding: code list completeness (note)

Code list completenessThe procedure code list provided is not all-encompassing; inclusion of a code does not guarantee it is a covered service or eligible for reimbursement.

Implication for claimsProviders should not assume coverage based solely on a code appearing in the list; verify against plan documents and provider contracts.

Coding guidanceClaims must be submitted using valid code combinations from HIPAA-approved code sets and coded per industry-standard guidelines.

Review and editsClaims are subject to code-edit protocols and may be reviewed against plan terms, contracts, medical policies, and coding software logic.

Provider responsibilityProviders are responsible for submitting accurate documentation and may be asked to provide additional documentation upon request.

Provider Responsibilities and Claim Review

Documentation Required

Submit accurate documentation; claims subject to review

Providers are responsible for submission of accurate documentation of services performed and must code claims using valid HIPAA-approved code sets and industry-standard coding guidelines. Claims are subject to code edit protocols and claim review against benefit terms, provider contracts, medical policies, and coding software logic; upon request, providers must submit any additional documentation.

Submit claims using valid HIPAA-approved code sets and industry-standard coding guidelines (e.g., UB Editor, AMA CPT, HCPCS, ICD-10-CM/PCS).
Claims are subject to code edit protocols and review against plan documents, provider contracts, medical policies, and coding software logic.
Provide additional documentation upon request to support the claim.

Definitions

Definition: in vitro chemosensitivity assays

DefinitionIn vitro chemosensitivity assays are laboratory tests that assess the sensitivity of tumor cells to anticancer drugs (examples listed include histoculture drug response assay and fluorescent cytoprint assay).

Reimbursement stanceBCBSIL considers in vitro chemosensitivity assays not reimbursable for all products unless overridden by specific plan documents.

Provider actionClaims for these assays should be submitted with accurate documentation and will be subject to claim review and code-edit protocols.

Definition: in vitro chemoresistance assays

DefinitionIn vitro chemoresistance assays are laboratory tests that assess tumor cell resistance to anticancer drugs (example: extreme drug resistance [EDR] assays).

Reimbursement stanceBCBSIL considers in vitro chemoresistance assays (e.g., EDR assays) not reimbursable for all products unless overridden by specific plan documents.

Claim handlingClaims for these assays are subject to review and may be denied as non-reimbursable per policy.