CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB017

Celiac Disease Testing

This policy defines BCBSNM reimbursement criteria for serologic, genetic, biopsy, and related testing used to diagnose or monitor celiac disease and specifies which tests or test formats are not reimbursable; it applies to providers submitting claims to Blue Cross and Blue Shield of New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyCeliac Disease Testing

Policy CodePolicy CPCPLAB017

Change TypeMultiple (adds non-reimbursable teststiming clarifiedcode removals)

Effective DateJan 3, 2026

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review.

SourceLink

POLICY UPDATE CHANGES

Serologic testing using an HLA-DQ-gluten tetramer-based assay, including flow cytometry-based HLA-DQ-gluten tetramer assays, is not reimbursable.

Codes 81376, 81377, 81382, 81383 were removed from the procedure code list.

Established monitoring intervals for IgA anti-TTG and for IgA-deficient patients using IgG assays after diagnosis.

Testing for asymptomatic individuals not at increased risk for developing celiac disease is not reimbursable.

13reimbursement rules

8example codes listed

2026-01-03plan effective

09/26/2025last review

Reimbursable and Non-Reimbursable Services

Reimbursable and non-reimbursable services

Reimbursable tests and non-reimbursable services for diagnosis and monitoring of celiac disease.

Covered when the following reimbursable diagnostic and monitoring criteria are met:

Diagnostic and monitoring tests

For individuals diagnosed with celiac disease who are IgA sufficient: IgA anti-tissue transglutaminase (anti‑TTG) serologic testing may be reimbursed at the following intervals: at first follow-up 3 to 6 months after diagnosis; every 6 months until anti‑TTG normalizes; then every 12 to 24 months.
For individuals diagnosed with celiac disease who are IgA deficient: testing for IgG endomysial antibodies, IgG deamidated gliadin peptide (DGP), or IgG TTG may be reimbursed at the following intervals: at first follow-up 3 to 6 months after diagnosis; every 6 months until IgG levels normalize; then every 12 to 24 months.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyCeliac Disease Testing

Policy CodePolicy CPCPLAB017

Change TypeMultiple (adds non-reimbursable teststiming clarifiedcode removals)

Effective DateJan 3, 2026

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review.

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 and Claims Submission

Documentation Required

Documentation and claims submission requirements

Providers are responsible for submitting accurate documentation and must code claims using valid, industry-standard code sets and guidelines. Claims are subject to code edit protocols and review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic; upon request, providers must submit additional documentation.

Submit claims using valid HIPAA-approved code sets and appropriate code combinations.
Code according to industry standards (UB, AMA CPT, HCPCS, ICD-10-CM/PCS, NDCs, DRG, CMS/NCCI guidelines).
Be prepared to provide additional documentation upon request to support the claim.
Claims may be denied, adjusted, or otherwise affected by code edits, plan benefit terms, provider contract terms, medical policies, or coding software logic.

Signs, Symptoms, and High-Risk Features

Signs, symptoms, and high‑risk features (Note 1)

Gastrointestinal symptomsUnexplained chronic or intermittent diarrhea; unexplained chronic or intermittent abdominal pain or bloating; recurrent nausea or vomiting

Nutritional and laboratory abnormalitiesUnexplained weight loss; unexplained iron deficiency anemia; unexplained vitamin B12 or folate deficiency; unexplained liver transaminase elevations

Dermatologic, endocrine, and systemic featuresDermatitis herpetiformis; type 1 diabetes; autoimmune hepatitis; primary biliary cirrhosis

Reproductive and bone manifestationsUnexplained subfertility or miscarriage; unexplained osteoporosis, osteomalacia, or low bone density

High‑risk genetic/syndromic associations and pediatric signsIndividuals with Down syndrome, Turner syndrome, or Williams‑Beuren syndrome; pediatric features include fatty stools, delayed puberty, failure to thrive, stunted growth, short stature

82784
83516
86231
86255
86256
86258
86364
88305

OpenPayer

Celiac Disease Testing

Reimbursable and Non-Reimbursable Services

Procedure Codes and Monitoring Intervals

Documentation and Claims Submission

Signs, Symptoms, and High-Risk Features