CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB023

Diagnosis of Idiopathic Environmental Intolerance — laboratory testing reimbursement

Laboratory management reimbursement criteria for tests related to idiopathic environmental intolerance (multiple chemical sensitivity) and related broad environmental/toxicant/nutritional profiling. Applies to providers submitting claims to Blue Cross and Blue Shield of New Mexico; plan documents and provider contracts govern in case of conflict.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyDiagnosis of Idiopathic Environmental Intolerance — laboratory testing reimbursement

Policy CodePolicy CPCPLAB023

Change TypeLiterature/references updated (reimbursement unchanged)

Effective DateApril 15, 2025

Next Review DateN/A

Key ActionSubmit accurate documentation and any additional records upon request to support claims and medical necessity determinations.

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review; reimbursement information unchanged.

Code 84999 was removed in a prior revision.

ManyNumber of reimbursable-excluded test categories

CPCPLAB023Policy identifier

04/15/2025Plan effective date

10 codesBilling unit maximums specified

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Policy Summary & Scope

This policy, Diagnosis of Idiopathic Environmental Intolerance (Policy Number CPCPLAB023), describes Blue Cross and Blue Shield of New Mexico's (BCBSNM) laboratory reimbursement criteria for tests related to idiopathic environmental intolerance (multiple chemical sensitivity) and related environmental/toxicant/nutritional profiling. It applies to providers submitting claims to BCBSNM and is effective April 15, 2025. Plan documents and provider contracts take precedence where they conflict with this policy.

Policy metadata

Policy identifierCPCPLAB023

Plan effective dateApril 15, 2025

Policy codeCPCPLAB023

StatusCURRENT

Scope summaryLaboratory management reimbursement criteria for tests related to idiopathic environmental intolerance (multiple chemical sensitivity) and related broad environmental/toxicant/nutritional profiling. Applies to providers submitting claims to Blue Cross and Blue Shield of New Mexico; plan documents and provider contracts govern in case of conflict.

Reimbursement Exclusion Criteria

Reimbursement exclusion criteria

Lists conditions and specimen types for which specified tests are not reimbursable.

ALL of the following

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.
For asymptomatic individuals, profiling of chlorinated pesticides (including DDE and DDT) using blood, serum, plasma, saliva, urine, and/or stool is not reimbursable.

Procedure Codes and Unit Limits

Procedure codes referenced (inclusion list)CPT|HCPCS|mixed

82108
82127	Amino acids; single, qualitative, each specimen (unit limit: 1 per date of service)
82136	Amino acids, 2 to 5 amino acids, quantitative (unit limit: 2 per date of service)
82139	Amino acids, 6 or more amino acids, quantitative (unit limit: 2 per date of service)
82300
82379
82380
82441
82495
82507

1–10 of 42

1/5

Billing unit limits

83918 unit limit2 per date of service

83919 unit limit1 per date of service

83921 unit limit2 per date of service

82127 unit limit1 per date of service

82136 unit limit2 per date of service

82139 unit limit2 per date of service

84585 unit limit1 per date of service

Billing, Documentation & Denial Risks

Documentation Required

Submit accurate documentation and additional records upon request

Providers are responsible for submission of accurate documentation of services performed and are urged to submit any additional documentation upon request to support claims and medical necessity determinations.

Billing Rule

Use valid code combinations and industry coding guidelines

Claims must be submitted using valid, HIPAA‑approved code sets and coded according to industry-standard coding guidelines; claims are subject to code edit protocols and claim review.

Use valid HIPAA‑approved code sets (UB, AMA CPT, HCPCS, ICD‑10, NDCs, DRG, CMS NCCI rules).
Claims are subject to code edit protocols and claim review including coding software logic and policy/contract terms.

Clinical & Administrative Background

Background: BCBSNM has implemented lab management reimbursement criteria that define a set of tests not eligible for reimbursement when used to diagnose idiopathic environmental intolerance or when performed for broad environmental/toxicant or nutritional profiling in asymptomatic or general-encounter settings. The policy document notes that plan documents and provider contracts govern in the event of any conflict and that providers should follow industry-standard coding and documentation practices.

Notes: The policy's literature and references were updated (most recently reflected in the 01/23/2025 revision with an effective date of 04/15/2025), but reimbursement guidance remained unchanged through those updates. Providers remain responsible for submitting accurate documentation and for complying with coding and claim review requirements described in plan documents.

Defined Terms

Definitions

Idiopathic Environmental Intolerance (Multiple Chemical Sensitivity)A condition characterized by non-specific symptoms attributed by the patient to low-level environmental exposures, for which laboratory tests designed to confirm the diagnosis are not reimbursable per this policy.

Document Updates

2025-01-23clarifiedLatest

Document updated with literature review; reimbursement information unchanged (non-material).

2024-04-29removed

Code 84999 was removed; document updated with literature review and reimbursement guidance unchanged (non-material).

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyDiagnosis of Idiopathic Environmental Intolerance — laboratory testing reimbursement

Policy CodePolicy CPCPLAB023

Change TypeLiterature/references updated (reimbursement unchanged)

Effective DateApril 15, 2025

Next Review DateN/A

Key ActionSubmit accurate documentation and any additional records upon request to support claims and medical necessity determinations.

SourceLink

On This Page

In asymptomatic individuals and/or during general encounters without abnormal findings, testing of blood, serum, plasma, saliva, urine, and/or stool for: carnitine sufficiency, oxidative stress and antioxidant sufficiency, detoxification adequacy, methylation sufficiency status, lipoic acid and CoQ10 sufficiency, and intestinal hyperpermeability is not reimbursable.

In asymptomatic individuals and/or during general encounters without abnormal findings, testing of blood, serum, plasma, saliva, urine, and/or stool for vitamin sufficiency, mineral sufficiency, and/or nutritional analysis is not reimbursable.

Breath hydrogen and/or methane testing is not reimbursable to assess or diagnose: idiopathic environmental intolerance; food allergies and sensitivities; carbohydrate sensitivity or intolerance; bacterial overgrowth (including SIBO); digestive disorders; constipation/diarrhea/flatulence; neurological/neuromuscular disorders; rosacea; obesity; or as part of a wellness visit/general encounter without abnormal findings.

In asymptomatic individuals and/or during general encounters without abnormal findings, testing of blood, serum, urine, cerebrospinal fluid, fingernails, hair, and/or stool for metals is not reimbursable.

Operational note: The policy lists specific laboratory tests and specimen types that are not reimbursable under the circumstances described, and these exclusions particularly apply to asymptomatic individuals and general encounters without abnormal findings. Examples include screening or profiling from blood, serum, plasma, saliva, urine, stool, hair, fingernails, and cerebrospinal fluid for volatile solvents, organic acids, organophosphates, phthalates, parabens, chlorinated pesticides (including DDE and DDT), metals, and a range of nutritional and metabolic sufficiency panels; breath hydrogen and methane testing is also excluded for the conditions and visit types listed.

1 per date of service

83497 unit limit1 per date of service

82656 unit limit1 per date of service

Denial Risk

Anticipate denials for excluded tests

Do not expect reimbursement for tests listed as excluded; submitting excluded tests for asymptomatic individuals or for the specified non‑reimbursable purposes may result in claim denials.

Excluded tests submitted for asymptomatic individuals (e.g., profiling of chlorinated pesticides, metals, nutritional/vitamin/mineral panels) risk denial.