CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB043

Evaluation of Dry Eyes

This policy describes Blue Cross Blue Shield of New Mexico's reimbursement stance for laboratory testing used to evaluate suspected dry eye disease and specifies which tear tests are reimbursable or not; it applies to providers submitting claims to BCBSNM.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyEvaluation of Dry Eyes

Policy CodePolicy CPCPLAB043

Change TypeNo material change

Effective DateAug 8, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and claims using valid coding; claims may be subject to code edits and additional documentation requests.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1test reimbursable (tear osmolarity)

2tests not reimbursable (MMP-9; lactoferrin and/or IgE)

4procedure codes listed

multipledocument literature references updated/reviewed

Reimbursement / Coverage Criteria

Reimbursement Criteria

Reimbursement stance for specific tear tests in individuals suspected of dry eye:

ALL of the following

Testing of tear osmolarity may be reimbursable for individuals suspected of having dry eye, including to help determine severity of disease.
Testing for MMP-9 protein in human tears is not reimbursable for individuals suspected of having dry eye disease based on comprehensive eye examination.
Testing for lactoferrin and/or IgE is not reimbursable for individuals suspected of having dry eye disease.
All other testing not discussed above for individuals suspected of having dry eye disease is not reimbursable.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyEvaluation of Dry Eyes

Policy CodePolicy CPCPLAB043

Change TypeNo material change

Effective DateAug 8, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and claims using valid coding; claims may be subject to code edits and additional documentation requests.

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.

Procedure Codes and Coding Notes

Procedure Codes Listed in PolicyCPT

82785
83516
83520
83861

Code list completeness

Scope of code listThe procedure code list is not all‑encompassing; presence of a code in the policy does not guarantee it is a covered service or eligible for reimbursement.

Verification requiredProviders should verify coverage and eligibility with the member’s specific plan and benefits — not all requirements apply to each product.

Claims subject to adjudicationInclusion of a code does not ensure payment; claims remain subject to plan rules and reimbursement determination.

Use correct codingProviders must submit accurate and specific procedure codes when billing; codes listed are examples, not an exhaustive set.

Documentation and Claims Submission Requirements

Documentation Required

Documentation and claims must use valid coding and may require additional documentation

Providers must submit accurate documentation of services performed and submit claims using valid HIPAA-approved code sets. Claims should be coded according to industry-standard coding guidelines (for example, Uniform Billing Editor, AMA CPT, HCPCS, ICD-10-CM/PCS, NDCs, DRG guidelines, CMS NCCI policy manual and CCI table edits). Claims are subject to code edit protocols and claim review against benefit coverage, provider contract language, medical and coding policies, and coding software logic; upon request, providers are urged to submit any additional documentation.

Submit claims using valid code combinations from HIPAA-approved code sets.
Code claims per industry-standard guidelines (e.g., CPT, HCPCS, ICD-10, NDCs, CMS NCCI/CCI edits).
Be prepared to provide additional documentation upon request for claim review or code edits.

Definitions and Reimbursement Criteria Notes

Reimbursement criteria (definition)

DefinitionLaboratory management reimbursement criteria: plan‑level rules that define when laboratory testing for evaluation of dry eye may be reimbursed.

Reimbursable test exampleTear osmolarity testing may be reimbursable for individuals suspected of having dry eye, including to help determine severity of disease.

Non‑reimbursable testsTesting for MMP‑9 protein, lactoferrin and/or IgE, and other tests not discussed in the policy are not reimbursable for suspected dry eye disease.

Product variabilityNot all requirements apply to each product; providers are urged to review specific Plan documents for eligible coverage.