CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB032

Oral Cancer Screening and Testing

Defines BCBSNM laboratory reimbursement criteria for oral cancer–related testing, including HPV tumor status tests for oropharyngeal squamous cell carcinoma; affects providers submitting claims to Blue Cross and Blue Shield of New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyOral Cancer Screening and Testing

Policy CodePolicy CPCPLAB032

Change TypeRevised reimbursement criteriaprocedure code updates

Effective DateJan 15, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and use valid HIPAA code sets; claims are subject to plan and coding rules.

SourceLink

POLICY UPDATE CHANGES

Revised reimbursement information to specify intent of test: 'To establish HPV tumor status…' and updated reimbursable test modalities.

Added code 0429U and removed code 87623 from the procedure code list.

Document updated with literature review and references revised (some added, some updated, others removed).

1Primary reimbursement criterion

0429UAdded code

87623Removed code

1.0Policy version

01/15/2025Plan effective

Coverage Criteria

HPV tumor status testing coverage

Reimbursement may be available when testing is used to establish HPV tumor status in oropharyngeal squamous cell carcinoma.

ALL of the following

High-risk HPV testing via mRNA E6/E7 expression testing.
Immunohistochemistry for high-risk HPV.

Procedure Codes and Coding Expectations

Procedure code updatesCPT

0429U	Added — specific testing code referenced as added in update history
87623	Removed — previously listed code removed per update history

Coding accuracy expectation

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyOral Cancer Screening and Testing

Policy CodePolicy CPCPLAB032

Change TypeRevised reimbursement criteriaprocedure code updates

Effective DateJan 15, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and use valid HIPAA code sets; claims are subject to plan and coding rules.

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.

Provider Actions and Submission Requirements

Documentation Required

Submit accurate documentation and use valid HIPAA code sets; claims are subject to plan, contract, and policy review

Providers are responsible for submitting accurate documentation of services performed and must submit claims using valid HIPAA-approved code sets and appropriate industry-standard coding guidelines. Claims are subject to code edit protocols and review against plan benefit terms, provider contract language, medical policies, clinical payment and coding policies, and coding software logic; additional documentation may be requested upon review.

Submit claims using valid code combinations from HIPAA-approved code sets (e.g., CPT, HCPCS, ICD-10-CM/PCS, NDC).
Code claims per industry standard coding guidelines (Uniform Billing Editor, AMA CPT, CMS NCCI, CCI edits, etc.).
Be prepared to provide additional documentation upon request for claim review.
Claims may be adjudicated according to plan documents and provider contract terms when conflicts arise.

OpenPayer

Oral Cancer Screening and Testing

Coverage Criteria

Procedure Codes and Coding Expectations

Provider Actions and Submission Requirements

Definitions