Lyme Disease Testing
This policy governs reimbursement criteria for laboratory testing for Lyme disease for Blue Cross Blue Shield of New Mexico members; it affects providers submitting claims for Lyme disease-related testing.
Document updated with literature review; reimbursement information unchanged.
Reimbursement information revised for clarity.
New policy created on 11/01/2022.
Lyme Disease Testing — Coverage Criteria
Lyme testing reimbursement criteria
Reimbursement is conditional based on clinical indications and test modality. Covered and not-covered scenarios are listed below.
ALL of the following
ONE of the following clinical presentations
- Individual has symptoms of Lyme disease AND history of travel to a region endemic for Lyme (with or without a history of a tick bite).
- Serologic two-tier testing is performed (sensitive EIA or immunofluorescence assay followed by Western immunoblot or FDA-cleared second EIA).
OR testing may be reimbursable for individuals with travel to an endemic region who present with
- Acute myocarditis or pericarditis of unknown cause.
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