CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB069

Immunohistochemistry

This policy defines reimbursement and coding guidance for immunohistochemistry (IHC) laboratory procedures for BCBSNM products and governs provider claim submission and coding expectations; applicability may vary by specific plan document.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyImmunohistochemistry

Policy CodePolicy CPCPLAB069

Change TypeNo material change

Effective DateMar 15, 2024

Next Review DateN/A

Key ActionSubmit accurate documentation and provide additional documentation upon request; code claims using valid HIPAA-approved code sets.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1 unit/specimen88342 rule

Max 13 units/DOS88341 rule

Up to 6 specimens/DOS88344 rule

HIPAA codesCoding expectation

Immunohistochemistry (IHC) Coverage and Reimbursement

IHC coverage and reimbursement criteria

Reimbursement guidance and applicability

Not all laboratory management reimbursement requirements apply to every product; providers must review individual plan documents for coverage eligibility.

Use CPT 88342 for the first single antibody procedure; reimbursed at one unit per specimen, up to four specimens per date of service.

Use CPT 88341 for each additional single antibody per specimen; reimbursed up to a maximum of 13 units per date of service.

Use CPT 88344 for each multiplex antibody per specimen; reimbursed for up to six specimens per date of service.

Inclusion of a code in procedure lists does not guarantee coverage; claims remain subject to the member's plan terms, provider contract language, medical policies, and code edit protocols.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyImmunohistochemistry

Policy CodePolicy CPCPLAB069

Change TypeNo material change

Effective DateMar 15, 2024

Next Review DateN/A

Key ActionSubmit accurate documentation and provide additional documentation upon request; code claims using valid HIPAA-approved code sets.

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.

Reimbursement Codes and Limits

IHC reimbursement codesCPTCovered

88342	First single antibody procedure; reimbursed at one unit per specimen, up to four specimens per date of service
88341	Each additional single antibody per specimen; reimbursed up to a maximum of 13 units per date of service
88344	Each multiplex antibody per specimen; up to six specimens per date of service

88342 specimen limit

LimitUp to 4 specimens per date of service for CPT 88342 (first single antibody procedure)

Reimbursement unitReimbursed at one unit per specimen for CPT 88342

Applicability noteProviders should confirm plan document eligibility as not all requirements apply to every product

88341 unit maximum

Maximum unitsMaximum 13 units per date of service for CPT 88341 (each additional single antibody)

UseApply CPT 88341 for each additional single antibody per specimen

Claim guidanceClaims must be submitted using valid HIPAA-approved code sets and may be subject to review

88344 specimen limit

LimitUp to 6 specimens per date of service for CPT 88344 (each multiplex antibody)

UseApply CPT 88344 for each multiplex antibody per specimen

Plan checkVerify coverage eligibility in the applicable plan document before billing

Provider Documentation and Claims Submission

Documentation Required

Submit accurate documentation and use HIPAA‑approved code sets

Providers must submit accurate documentation of services performed and code claims using valid HIPAA‑approved code sets and industry standard coding guidelines. Providers should be prepared to provide additional documentation upon request to support claim review.

Use valid code combinations from HIPAA‑approved code sets (e.g., UB, CPT, HCPCS, ICD‑10, NDC).
Follow industry standard coding guidance including AMA CPT, CMS NCCI edits and DRG guidelines.
Provide additional documentation when requested during claim review.

Plan Documents and Covered Services Definitions

Plan documents

DefinitionCertificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents

Governing authorityIf a conflict arises between this CPCP and a plan document, the plan document will govern

ApplicabilityNot all lab management reimbursement requirements apply to every product; providers should review plan documents for eligible coverage

Covered Services

DefinitionCovered Services: Services to which a member is entitled under a specific plan document

Conflict resolutionPlan documents govern conflicts with this CPCP; provider contracts govern over CPCP where applicable

Claims and coverage noteInclusion of a procedure code does not guarantee coverage; claims are subject to plan terms, provider contract language, medical policies, and code edit protocols