CurrentBlue Cross Blue Shield - New MexicoPolicy N/A

2026 Non-Covered Code List — Fully Insured

List of procedure, CPT/HCPCS, and internal service codes that Blue Cross Blue Shield of New Mexico does not cover for fully insured members effective January 1, 2026; intended for providers and billing staff to determine non-covered services and billing denial risk.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

Policy2026 Non-Covered Code List — Fully Insured

Policy CodePolicy N/A

Change TypeNo material coverage changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionCheck member eligibility and benefits through Availity or the payer portal and obtain prior authorization when required before rendering services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Multiplenon-covered codes listed

1/1/2026primary effective date

Jun 2026file update month

Fully insuredpopulation specified

Non-Covered Services and Scope

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.

Non-Covered Codes (CPT/HCPCS/U-codes and Internal Codes)

Non-covered codes (examples)mixedNot Covered

7957	Weight Loss
11200	Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
11201	Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof
0084U	Red blood cell antigen typing, DNA, genotyping of 10 blood groups with phenotype prediction of 37 red blood cell antigens
0086U	Infectious disease (bacterial and fungal), organism identification, blood culture, using rRNA FISH, 6 or more organism targets, reported as positive or negative with phenotypic minimum inhibitory concentration (MIC)-based antimicrobial susceptibility
0091U	Oncology (colorectal) screening, cell enumeration of circulating tumor cells, utilizing whole blood, algorithm, for the presence of adenoma or cancer
0092U	Oncology (lung), three protein biomarkers, immunoassay using magnetic nanosensor technology, plasma, algorithm reported as risk score for likelihood of malignancy

Non-covered lab and molecular codes (continued)mixedNot Covered

0093U	Prescription drug monitoring, evaluation of 65 common drugs by LC-MS/MS, urine, each drug reported detected or not detected
0095U	Eosinophilic esophagitis, 2 protein biomarkers (Eotaxin-3 and Major Basic Protein-1), ELISA, specimen obtained by esophageal string test device, algorithm reported as probability of active or inactive eosinophilic esophagitis
0096U	Human papillomavirus (HPV), high-risk types, male urine
0105U	Nephrology (chronic kidney disease), multiplex ECLIA of TNFR1, TNFR2, and KIM-1 combined with longitudinal clinical data, algorithm reported as probability score for rapid kidney function decline
0107U	Clostridium difficile toxin(s) antigen detection by immunoassay technique, stool, qualitative, multiple-step method
0108U	Gastroenterology (Barrett's esophagus), whole slide digital imaging, morphometric analysis, computer-assisted quantitative immunolabeling of 9 protein biomarkers and morphology, algorithm reported as risk of progression to high-grade dysplasia or cancer
0109U	Infectious disease (Aspergillus species), real-time PCR for detection of DNA from 4 species, blood/lavage/tissue
0110U	Prescription drug monitoring, oral oncology drug(s), definitive tandem mass spectrometry with chromatography, serum or plasma, quantitative report with steady-state range
0112U	Infectious agent detection and identification, targeted sequence analysis (16S and 18S rRNA genes) with drug-resistance gene
0115U	Respiratory infectious agent detection by nucleic acid, 18 viral types/subtypes and 2 bacterial targets, amplified probe technique, including multiplex RT for RNA targets

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Internal plan non-covered categoriesmixedNot Covered

213AA	Proc/Treat/Equip/Ins/Non-Covered
213BA	OTC Drugs Non-Covered
213CA	Vision/Hear/Dental Non-Covered
213EA	Assist Disabled/Misc Non-Covered
213FA	Corr Eye Surgery Non-Covered
213GA	Premiums Non-Covered
213HA	Copays Non-Covered
213JA	Limited Purpose HCA Non-Covered
213KA	Preventative Care Non-Covered
213LA	Long Term Care Non-Covered

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Provider Requirements and Billing Impact

Prior Authorization

Prior Authorization May Be Required

Prior authorization may be required for some services. Check member-specific requirements and the appropriate vendor for authorization (BCBSNM or Carelon) before scheduling services.

Verify whether prior authorization is required via Availity® Essentials (availity.com) or the payer/vendor portal.
Some services/members require prior authorization through Blue Cross and Blue Shield of New Mexico (BCBSNM); others use Carelon Medical Benefits Management for utilization management.

Note

Provider Action — Verify Before You Schedule

Providers must verify authorization and benefits prior to rendering services. Do not assume prior authorization or an eligibility check guarantees payment.

Check member eligibility and benefits before each service.
Obtaining prior authorization is not a substitute for verifying eligibility and benefits.

Note

Eligibility and Benefits Check Required

Always check eligibility and benefits before providing services. Use Availity® Essentials or your preferred vendor portal to confirm coverage, prior authorization requirements, and vendor routing.

Use Availity® Essentials (availity.com) or the payer/vendor portal to confirm member coverage and any pre-notification or prior authorization requirements.
If you have questions about a member's coverage, contact the phone number on the member's ID card.

Denial Risk

Denial Risk — Missing Prior Authorization

Services performed without required prior authorization will be denied for payment and providers may not bill or seek reimbursement from BCBSNM members.

If prior authorization is required and not obtained, the claim will be denied and the provider is responsible for the service cost.
Denials for missing prior authorization are not mitigated by later authorizations or eligibility checks.

Specific Tests and Services Not Covered

The following molecular, genomic, and specialized laboratory procedure codes are listed as not covered on the 2026 Non-Covered Code List: examples include U-codes such as 0084U (red blood cell antigen genotyping), 0086U (rRNA FISH organism identification with MIC), 0091U (circulating tumor cell enumeration), 0092U (lung protein biomarker immunoassay), 0093U (prescription drug monitoring by LC-MS/MS), 0095U (eosinophilic esophagitis protein biomarkers by ELISA), 0096U (high-risk HPV, male urine), 0105U (CKD biomarker panel with algorithm), 0107U (C. difficile toxin antigen immunoassay), 0108U (Barrett's esophagus whole-slide digital morphometric analysis), 0109U (Aspergillus PCR), 0110U (oral oncology drug monitoring by tandem mass spectrometry), 0112U (16S/18S targeted sequence analysis with resistance gene), 0115U (respiratory pathogen multiplex nucleic acid test), 0116U (prescription drug monitoring with oral fluid confirmation), 0117U (pain-management endogenous analyte panel), 0119U (ceramides by LC-MS/MS with risk score), 0121U and 0122U (sickle cell microfluidic flow adhesion tests), 0123U (RBC mechanical fragility), 0140U, 0141U, 0142U (fungal and bacterial pathogen ID panels), and 0152U (microbial cell-free DNA, untargeted NGS).

OpenPayer

2026 Non-Covered Code List — Fully Insured

Non-Covered Services and Scope

Non-Covered Codes (CPT/HCPCS/U-codes and Internal Codes)

Provider Requirements and Billing Impact

Ordering and Verification Procedures

Specific Tests and Services Not Covered