CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB023

Diagnosis of Idiopathic Environmental Intolerance

This reimbursement/coding policy governs which laboratory tests and related procedure codes for diagnosis or screening of idiopathic environmental intolerance and related profiles are reimbursable for Blue Cross Blue Shield of New Mexico members; it applies to providers submitting claims and to plan-specific coverage determinations.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyDiagnosis of Idiopathic Environmental Intolerance

Policy CodePolicy CPCPLAB023

Change TypeNon-material revisioncode removal noted

Effective DateApr 29, 2024

Next Review Date

Key ActionSubmit accurate documentation and provide additional records upon request to support claims and coding.

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review; reimbursement information unchanged.

Code 84999 was removed from the code list.

MultipleDistinct test categories listed as not reimbursable

33+Procedure codes included

11 itemsPer‑date unit limits

04/29/2024Policy effective

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-reimbursable tests and contexts

Reimbursement information lists tests and categories that are not reimbursable in specified circumstances.

Laboratory tests designed to confirm the diagnosis of idiopathic environmental illness are not reimbursable in all circumstances.

Screening of blood, saliva, serum, plasma, urine, and/or stool samples for volatile solvents, organic acids, and organophosphates is not reimbursable in all circumstances.

Profiling of phthalates and parabens using blood, serum, plasma, saliva, urine, and/or stool samples is not reimbursable in all circumstances.

Asymptomatic / general encounter restrictions

Profiling of chlorinated pesticides (including DDE and DDT) using blood, serum, plasma, saliva, urine, and/or stool samples is not reimbursable for asymptomatic individuals.
Testing of blood, serum, plasma, saliva, urine, and/or stool samples for carnitine sufficiency, oxidative stress and antioxidant sufficiency, detoxification adequacy, methylation sufficiency status, lipoic acid and CoQ10 sufficiency, and intestinal hyperpermeability is not reimbursable for asymptomatic individuals or during general encounters without abnormal findings.
Testing of blood, serum, plasma, saliva, urine, and/or stool samples for vitamin sufficiency, mineral sufficiency, and nutritional analysis is not reimbursable for asymptomatic individuals or during general encounters without abnormal findings.
Testing of blood, serum, urine, cerebrospinal fluid, fingernails, hair, and/or stool samples for metals is not reimbursable for asymptomatic individuals or during general encounters without abnormal findings.

Use of a breath hydrogen and/or breath methane test is not reimbursable to assess or diagnose idiopathic environmental intolerance.

ALL of the following

Use of a breath hydrogen and/or breath methane test is not reimbursable to assess or diagnose food allergies and sensitivities.
Use of a breath hydrogen and/or breath methane test is not reimbursable to assess or diagnose carbohydrate sensitivity or intolerance.
Use of a breath hydrogen and/or breath methane test is not reimbursable to assess or diagnose bacterial overgrowth, including small intestinal bacterial overgrowth (SIBO).
Use of a breath hydrogen and/or breath methane test is not reimbursable to assess or diagnose digestive disorders, including constipation, diarrhea, or flatulence.
Use of a breath hydrogen and/or breath methane test is not reimbursable to assess or diagnose neurological or neuromuscular disorders.

Procedure Codes and Unit Limits

Procedure codes mentionedmixed

82108
82127
82136
82139
82300
82379
82380
82441
82495
82507

1–10 of 42

1/5

Covered CPT CodesCPTCovered

No codes listed

Not covered CPT CodesCPTNot Covered

No codes listed

Experimental CodesmixedExperimental

No codes listed

inv-03: 83919 (Organic acids; qualitative)

Procedure code83919 (Organic acids; qualitative, each specimen)

Unit limitMaximum 1 unit per date of service is ALLOWED.

Source noteListed in Reimbursement Policy section specifying per-date-of-service allowance.

inv-04: 83918 (Organic acids; total, quantitative)

Procedure code83918 (Organic acids; total, quantitative, each specimen)

Unit limitMaximum 2 units per date of service is ALLOWED.

Source noteListed as item 1 in Reimbursement Policy with per-date-of-service allowance.

inv-05: 83921 (Organic acid, single, quantitative)

Procedure code83921 (Organic acid, single, quantitative)

Unit limitMaximum 2 units per date of service is ALLOWED.

Source noteListed in Reimbursement Policy as item 3 with per-date-of-service allowance.

inv-06: 82127 (Amino acids; single, qualitative)

Procedure code82127 (Amino acids; single, qualitative, each specimen)

Unit limitMaximum 1 unit per date of service is ALLOWED.

Source noteListed as item 4 in Reimbursement Policy with per-date-of-service allowance.

inv-07: 82136 (Amino acids, 2 to 5 amino acids, quantitative)

Procedure code82136 (Amino acids, 2 to 5 amino acids, quantitative, each specimen)

Unit limitMaximum 2 units per date of service is ALLOWED.

Source noteListed as item 5 in Reimbursement Policy with per-date-of-service allowance.

inv-08: 82139 (Amino acids, 6 or more, quantitative)

Procedure code82139 (Amino acids, 6 or more amino acids, quantitative, each specimen)

Unit limitMaximum 2 units per date of service is ALLOWED.

Source noteListed as item 6 in Reimbursement Policy with per-date-of-service allowance.

inv-09: 84585 (Vanillylmandelic acid, urine)

Procedure code84585 (Vanillylmandelic acid (VMA), urine)

Unit limitMaximum 1 unit per date of service is ALLOWED.

Source noteListed as item 7 in Reimbursement Policy with per-date-of-service allowance.

inv-10: 83150 (Homovanillic acid)

Procedure code83150 (Homovanillic acid (HVA))

Unit limitMaximum 1 unit per date of service is ALLOWED.

Source noteListed as item 8 in Reimbursement Policy with per-date-of-service allowance.

inv-11: 83497 (Hydroxyindolacetic acid, 5-(HIAA))

Procedure code83497 (Hydroxyindolacetic acid, 5-(HIAA))

Unit limitMaximum 1 unit per date of service is ALLOWED.

Source noteListed as item 9 in Reimbursement Policy with per-date-of-service allowance.

inv-12: 82656 (Elastase, pancreatic, fecal)

Procedure code82656 (Elastase, pancreatic (EL-1), fecal, qualitative or semi-quantitative)

Unit limitMaximum 1 unit per date of service is ALLOWED.

Source noteListed as item 10 in Reimbursement Policy with per-date-of-service allowance.

Provider Documentation and Claims Requirements

Documentation Required

Provider claim documentation and review — responsibilities

Providers are responsible for submission of accurate documentation of services performed and for coding claims using valid code combinations from HIPAA‑standard code sets. Claims should be coded according to industry standard coding guidelines, including but not limited to: Uniform Billing Manual, American Medical Association CPT (and CPT Assistant) guidance, HCPCS, ICD‑10‑CM/PCS, National Drug Codes, DRG guidelines, and CMS coding guidance such as the National Correct Coding Initiative and CCI table edits.

Claims are subject to automated and manual code edit protocols and review.
Claim review may include verification against benefit coverage, provider contract terms, medical policies, clinical payment and coding policies, and coding/software logic.
Providers may be asked to submit additional documentation to support services billed; respond promptly to documentation requests to avoid claim denials or payment delays.

OpenPayer

Diagnosis of Idiopathic Environmental Intolerance

Coverage and Reimbursement Criteria

Procedure Codes and Unit Limits

Provider Documentation and Claims Requirements

Definitions and Descriptions