CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB034

Salivary Hormone Testing

Defines BCBSNM reimbursement and coding guidance for salivary hormone tests, including when late-night salivary cortisol may be reimbursed for Cushing syndrome and when salivary hormone testing is not reimbursable for various other indications. Applies to providers submitting claims to Blue Cross and Blue Shield of New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicySalivary Hormone Testing

Policy CodePolicy CPCPLAB034

Change TypeAdded procedure code

Effective DateJan 15, 2025

Next Review Date

Key ActionConfirm plan-specific coverage before billing and submit accurate documentation with valid codes; inclusion of a procedure code does not guarantee reimbursement.

SourceLink

POLICY UPDATE CHANGES

Added code 0462U.

1Cushing indication

11Procedure codes listed

1Policy updates

≥1References

Coverage Criteria for Salivary Hormone Testing

Reimbursable indication

Covered when ALL of the following are met

Cushing syndrome indication: Late night salivary cortisol testing may be reimbursable for the diagnosis of Cushing syndrome.

From reimbursement guidance: reimbursable for diagnosis of Cushing syndrome (late night salivary cortisol).

Not medically necessary / not reimbursable

Not reimbursable for the following indications

Multiple non‑covered indications: Screening, diagnosis, and/or monitoring of menopause, infertility, endometriosis, polycystic ovary disease (PCOS), premenstrual syndrome, osteoporosis, sexual dysfunction, seasonal affective disorder, depression, multiple sclerosis, sleep disorders, or diseases related to aging.

Claims for these indications are not reimbursable.

Salivary hormone testing is addressed differently depending on the clinical indication. Late‑night salivary cortisol testing has recognized utility and may be reimbursable for the diagnosis of Cushing syndrome. Conversely, salivary hormone assays used for the screening, diagnosis, or monitoring of a variety of other conditions are excluded from reimbursement. Providers should therefore confirm that testing is ordered specifically for evaluation of Cushing syndrome (late‑night salivary cortisol) when seeking coverage; tests ordered for other purposes are subject to denial as not reimbursable.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicySalivary Hormone Testing

Policy CodePolicy CPCPLAB034

Change TypeAdded procedure code

Effective DateJan 15, 2025

Next Review Date

Key ActionConfirm plan-specific coverage before billing and submit accurate documentation with valid codes; inclusion of a procedure code does not guarantee reimbursement.

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.

Use of salivary hormone testing is not reimbursable for the following indications: screening, diagnosis, and/or monitoring of menopause, infertility, endometriosis, polycystic ovary disease (PCOS), premenstrual syndrome, osteoporosis, sexual dysfunction, seasonal affective disorder, depression, multiple sclerosis, sleep disorders, or diseases related to aging.

Indications Considered Covered

Diagnosis of Cushing syndrome using late-night salivary cortisol testing

May be reimbursable per policy.

Diagnosis of Cushing syndrome: Late night salivary cortisol testing may be reimbursable for the diagnosis of Cushing syndrome.

Late‑night salivary cortisol is a noninvasive screening assay for Cushing syndrome; reimbursement is limited to this diagnostic indication per policy.

Not Covered Uses

Salivary hormone testing is specifically not covered for evaluation of menopause, infertility, endometriosis, polycystic ovary disease (PCOS), premenstrual syndrome, osteoporosis, sexual dysfunction, seasonal affective disorder, depression, multiple sclerosis, sleep disorders, and conditions related to aging. Claims submitted for these indications may be denied as not reimbursable.

Definitions

Late‑night salivary cortisol testing

DefinitionLate‑night salivary cortisol testing is a noninvasive assay used as a screening test for Cushing syndrome and may be reimbursable for that diagnosis.

Clinical contextUsed to assess late‑night cortisol levels as part of diagnostic evaluation for suspected Cushing syndrome.

Reimbursement noteMay be reimbursable specifically for the diagnosis of Cushing syndrome; other salivary hormone testing indications are not reimbursable.

Non‑reimbursable usesSalivary hormone testing is not reimbursable for screening, diagnosis, or monitoring of menopause, infertility, endometriosis, PCOS, premenstrual syndrome, osteoporosis, sexual dysfunction, seasonal affective disorder, depression, multiple sclerosis, sleep disorders, or diseases related to aging.

Supporting evidencePolicy references validation and diagnostic accuracy studies of late‑night salivary cortisol (e.g., Doi 2013; Antonelli 2015) and reviews on salivary cortisol measurement methods.

Procedure and Billing Codes

Procedure codes listedmixed

82530
82533
82626
82627
82670
82671
82672
82677
82679
82681

1–10 of 17

1/2

Covered CPT CodesCPTCovered

No codes listed

Not covered CPT/HCPCS CodesmixedNot Covered

No codes listed

Provider Actions, Documentation, and Billing Guidance

Prior Authorization

Procedure codes and prior authorization note

Procedure codes are provided for billing reference only; inclusion does not guarantee coverage. Prior authorization requirements may apply per the member's plan — verify benefits and obtain any required prior authorization before performing salivary hormone testing.

Verify member-specific coverage and prior authorization requirements before testing.
Inclusion of an HCPCS/CPT/CPT II code in this policy is not a guarantee of payment.

Note

Provider responsibilities and governance

If a conflict exists between this clinical payment and coding policy and a member’s plan document or provider contract, the plan document or contract governs. BCBSNM retains discretion in interpreting and applying this policy.

Providers must follow applicable plan documents (e.g., Certificates of Benefits, Summary Plan Descriptions).
Provider contracts supersede this policy when there is a conflict.

Documentation Required

Claims documentation and coding

Providers are responsible for accurate documentation and coding. Upon request, submit additional records to support medical necessity. Claims are subject to code-edit protocols and review against benefit terms, provider contract language, and coding policies.

Use HIPAA-approved code sets and follow industry coding guidelines (CPT, HCPCS, ICD-10-CM, UB, NDC, CCI edits).
Be prepared to provide clinical documentation (e.g., diagnostic rationale, testing timestamps for late-night salivary cortisol) when requested.

Denial Risk

Denial triggers for non‑covered indications

Claims for salivary hormone testing for screening, diagnosis, or monitoring of menopause, infertility, endometriosis, PCOS, premenstrual syndrome, osteoporosis, sexual dysfunction, seasonal affective disorder, depression, multiple sclerosis, sleep disorders, or age‑related conditions are not reimbursable and may be denied.

Common denial reasons: testing for non‑covered indications listed above.
Late‑night salivary cortisol for diagnosis of Cushing syndrome may be reimbursable when supported by documentation.

Background and Clinical Context

Salivary hormone assays measure steroid hormones and are used in multiple clinical contexts. This policy distinguishes a reimbursable use—late‑night salivary cortisol for evaluation of Cushing syndrome—from numerous other clinical applications where salivary testing lacks coverage. Clinicians and billing staff should be aware that, except for the possible Cushing syndrome indication, salivary hormone testing for reproductive, mood, sleep, neurodegenerative, bone health, sexual function, or age‑related concerns is considered not reimbursable under this policy.