CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABO34

Salivary Hormone Testing

Laboratory policy governing reimbursement and coding criteria for salivary hormone tests for Blue Cross Blue Shield of New Mexico members and participating providers.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicySalivary Hormone Testing

Policy CodePolicy CPCPLABO34

Change TypeNew policy with clarifications and reference updates

Effective DateJun 15, 2023

Next Review Date

Key ActionConfirm plan-specific prior authorization and submit accurate documentation and valid HIPAA-approved codes to support coverage eligibility.

SourceLink

POLICY UPDATE CHANGES

New policy implemented with literature review and reimbursement criteria.

Reimbursement information revised for clarity.

References updated; some revised and others removed.

1.0policy version

2023-04-12approval date

2023-06-15plan effective date

16codes referenced

Coverage Criteria for Salivary Hormone Testing

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Covered and Not Covered Indications

Coverage stance summarized

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

Providers should confirm applicability by product/plan.

Not reimbursable indications: Salivary hormone testing for 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 is not reimbursable.

Salivary hormone testing is not reimbursable for the screening, diagnosis, or monitoring of the following conditions: 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.

Use of salivary hormone testing for the above-listed non-reimbursable indications is considered not reimbursable under this policy and claims submitted for these purposes are not eligible for payment per the terms of this policy.

Indications That May Be Covered

Diagnosis of Cushing syndrome using late-night salivary cortisol

Covered when ALL of the following are met:

Required criteria

Indication: Clinical concern for Cushing syndrome (appropriate signs/symptoms) documented in the medical record.
Test: Late night salivary cortisol testing is ordered specifically for evaluation/diagnosis of Cushing syndrome.
Product applicability: Provider has confirmed that the member’s product/plan allows reimbursement for this test per plan documents.

Not reimbursable - other indications: Salivary hormone testing for menopause, infertility, endometriosis, PCOS, premenstrual syndrome, osteoporosis, sexual dysfunction, seasonal affective disorder, depression, multiple sclerosis, sleep disorders, or diseases related to aging is not reimbursable under this policy.

Coding and Procedure Codes

Codes referencedCPT

82530
82533
82626
82627
82670
82671
82672
82677
82679
82681

1–10 of 16

1/2

HCPCS Codes (referenced)HCPCS

No codes listed

Use case threshold — late-night salivary cortisol

Allowed useLate-night salivary cortisol testing: may be reimbursable for the diagnosis of Cushing syndrome.

Restricted to diagnosisNot indicated as reimbursable for routine screening, monitoring, or other diagnostic uses beyond Cushing syndrome per this policy.

Plan applicabilityReimbursement may vary by product; providers should review plan documents for eligible coverage.

Provider Responsibilities and Prior Authorization

Note

Prior authorization and product-specific applicability

BCBSNM has implemented certain lab management reimbursement criteria. Not all requirements apply to each product. Providers should review plan documents for eligible coverage for services rendered.

Not all lab management reimbursement requirements apply to every product — verify the member's plan documents and benefit details before ordering or billing.
Providers are responsible for submission of accurate documentation of services performed and must submit claims using valid HIPAA-approved code sets (e.g., CPT, HCPCS, ICD-10, NDC) and industry-standard coding guidelines.

Documentation Required

Documentation submission

Providers are responsible for submission of accurate documentation and are urged to provide additional documentation upon request to support medical necessity and coding. Claims are subject to review against plan documents, provider contracts, medical policies, clinical payment and coding policies, and automated code-edit protocols.

Submit claims coded appropriately according to industry standard coding guidelines (UB, AMA CPT, HCPCS, ICD-10-CM/PCS, DRG, NDC, CMS NCCI/CCI edits).
Upon request, provide supporting documentation to substantiate services billed.

Denial Risk

Coding and documentation noncompliance

Claims may be denied or pended if coding and documentation do not comply with plan/provider contract requirements or if invalid code combinations from HIPAA-approved code sets are submitted. Providers should confirm correct coding and modifier usage and resolve any code edit denials per payer guidance.

Claims must use valid HIPAA-approved codes and comply with CMS/NCCI edits — noncompliant claims can be denied.
Denials or adjustments may occur for incomplete documentation, incorrect coding, or failure to follow plan-specific authorization rules.

Note

Providers should follow policy-level instructions and alerts in plan documents and prior authorization systems prior to service delivery.

Check product-specific prior authorization requirements and any lab management rules before ordering tests.

Ordering Requirements

Step Therapy

Follow plan documents for ordering and eligibility; confirm product applicability

Providers must follow the member's plan documents for eligibility and product applicability; not all ordering or reimbursement requirements in this policy apply to every product.

Review Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents to confirm ordering and coverage rules.
Confirm whether prior authorization or other plan‑specific requirements apply before performing or billing the test.