CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABO48

Folate Testing

Defines Blue Cross and Blue Shield of New Mexico's reimbursement stance for serum, RBC, and folate receptor autoantibody testing for members; applies to providers submitting claims to BCBSNM.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyFolate Testing

Policy CodePolicy CPCPLABO48

Change TypeClarified, Added, Revised

Effective DateJan 15, 2025

Next Review Date

Key ActionProviders must submit accurate documentation of services performed and provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review; Reimbursement Information unchanged; References revised.

For all situations, folate receptor autoantibody testing is not reimbursable.

Document first published as new policy on 11/01/2022.

3distinct reimbursement rules listed

3procedure codes listed

2025-01-15Plan effective date

10/30/2024Approval / last review date

Folate Testing Coverage Criteria

Folate testing coverage criteria

Reimbursement Information

ALL of the following

ONE of
- Individual is diagnosed with megaloblastic anemia or macrocytic anemia.
- The megaloblastic anemia and/or macrocytosis does not resolve after folic acid treatment.
Measurement of serum folate concentration may be reimbursable under these circumstances.

For all indications not described above, measurement of serum folate concentration is not reimbursable.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyFolate Testing

Policy CodePolicy CPCPLABO48

Change TypeClarified, Added, Revised

Effective DateJan 15, 2025

Next Review Date

Key ActionProviders must submit accurate documentation of services performed and provide additional documentation upon request.

SourceLink

On This Page

Procedure Codes and Notes

Listed procedure codesmixed

82746	Folate; serum
82747	Folate; RBC
0399U	Folate receptor autoantibody (likely proprietary/other molecular)

Code inclusion notemixed

No codes listed

Code inclusion note

Scope of code listThe procedure code list is not all-encompassing; inclusion of a code does not guarantee it is a covered service or eligible for reimbursement.

Codes referenced in this policy82746 (Folate; serum); 82747 (Folate; RBC); 0399U (Folate receptor autoantibody)

Coding system noteCodes come from mixed code sets; providers must submit claims using valid, industry-standard HIPAA-approved code combinations.

Provider Responsibilities and Claim Review

Documentation Required

Submit accurate documentation and provide records on request

Providers are responsible for submission of accurate documentation of services performed and are urged to submit any additional documentation upon request.

Billing Rule

Claims subject to edits, review, and contractual/benefit rules

Claims are subject to code edit protocols and review, and adjudication may be influenced by provider contract language, benefit coverage terms, medical and coding policies, and coding software logic.

Use valid code combinations from HIPAA‑approved code sets and code according to industry standard guidelines (CPT, HCPCS, ICD‑10, DRG, CCI edits, etc.).
Claim submissions may be edited by code edit protocols and subject to claim review per benefit terms and provider contracts.

Plan Documents and Governing Coverage Documents

Plan documents

Governing documentsPlan documents (e.g., Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions) govern over this policy in case of conflict.

Provider responsibilityProviders are urged to review plan documents for eligible coverage for services rendered.

Policy interpretationBCBSNM may use reasonable discretion in interpreting and applying this policy, with full and final discretionary authority as provided under applicable plan documents.