Coronavirus Testing in the Outpatient Setting
Reimbursement criteria and coding guidance for outpatient COVID‑19 diagnostic and serologic testing under Blue Cross Blue Shield of New Mexico; applies to providers submitting claims to the Plan and varies by product and plan documents.
Edited reimbursement language to remove 'including rapid molecular tests' as duplicative and clarified wording by adding 'any of' to indicate either situation applies for testing.
Removed reimbursement items #6 and #7 as those are addressed in CPCPLAB045 Pathogen Panel Testing, and deleted Note 5.
Removed CPT/HCPCS codes 86318 and 87428 from the policy.
References were revised and updated following literature review (multiple reference additions and deletions).
Previously removed and added codes across prior updates (e.g., removal of codes 86790, 87631-87633, 87797, 87799, 0115U, 0202U, 0223U, 0225U, C9803, G2023-G2024, U0003-U0005; addition of 0408U earlier).
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.