CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB032

Oral Cancer Screening and Testing

Defines BCBSNM reimbursement and coding guidance for oral/oropharyngeal cancer screening and high-risk HPV testing for members; applies to providers submitting claims under BCBSNM products (review plan documents for product-specific applicability).

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyOral Cancer Screening and Testing

Policy CodePolicy CPCPLAB032

Change TypeNon-material revisions and title update

Effective DateNov 1, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

Reimbursement information revised for clarity.

Title changed from 'Oral Screening Lesion Identification Systems and Genetic Screening' to current title.

Document updated with literature review and references revised.

1.0policy version

Nov 1, 2023Plan effective date

Jul 17, 2023Last review

8Procedure codes cited

Coverage and Reimbursement Criteria

High-risk HPV testing reimbursement criteria

Reimbursement may be available when testing meets clinical context:

ALL of the following

Diagnosis: oropharyngeal squamous cell carcinoma (testing for high-risk HPV may be reimbursable).
Testing methods covered include mRNA expression testing for HPV E6/E7 or immunohistochemistry.

Procedure Codes and Coding Standards

Procedure codes cited (not all-inclusive)mixed

81599
82397
87623
87624
87625
88341
88342
0296U

Coding standards — required code sets and guidelines

Required code sets

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyOral Cancer Screening and Testing

Policy CodePolicy CPCPLAB032

Change TypeNon-material revisions and title update

Effective DateNov 1, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

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.

Documentation, Claims, and Provider Responsibilities

Documentation Required

Submit accurate documentation and expect claim review

Providers are responsible for submitting accurate documentation of services performed and must submit claims using valid code combinations from HIPAA‑approved code sets; claims should be coded per industry standard coding guidelines (for example CPT, HCPCS, ICD‑10, NDC, DRG, NCCI/CCI edits). Claims are subject to code edit protocols and review, and providers may be asked to supply additional documentation upon request.

Submit claims using valid code combinations from HIPAA‑approved code sets.
Code claims per industry standard guidelines (UB Editor, AMA CPT, CPT Assistant, HCPCS, ICD‑10 CM/PCS, NDC, DRG, CMS NCCI/CCI edits).
Be prepared to provide additional documentation if requested during claim review.

Definitions and Plan Documents

Plan documents

DefinitionPlan documents include Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

Governing authorityIf a conflict exists between this CPCP and a plan document under which a member is entitled to Covered Services, the plan document will govern.

Provider contractsIf a conflict exists between this CPCP and a provider contract, the provider contract will govern.

High-risk HPV testing — reimbursable testing

Test indicationHigh-risk HPV testing may be reimbursable for individuals with oropharyngeal squamous cell carcinoma.

Accepted test methodsReimbursable methods include mRNA expression testing for HPV E6/E7 or immunohistochemistry.

Coverage noteReimbursement depends on meeting clinical context; providers should confirm eligibility with applicable plan documents.