CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB014

Prenatal Screening (Nongenetic)

Reimbursement and coding criteria for routine nongenetic prenatal screening tests for pregnant individuals under Blue Cross and Blue Shield of New Mexico products; providers should verify plan documents for product-specific applicability.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyPrenatal Screening (Nongenetic)

Policy CodePolicy CPCPLAB014

Change TypeRevised (coding updates and clarifications)

Effective DateJan 15, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review and code edit protocols.

SourceLink

POLICY UPDATE CHANGES

Reimbursement Information updated (removed reference to CPCPLAB022, updated recommended testing types for HIV, Hep B, Hep C, spelling, and clarified Group B strep timing and third-trimester and FFN guidance).

Note referencing other lab policies for thyroid and Zika testing (CPCPLAB019 and CPCPLAB052).

Version 1.0policy version

2025-01-15plan effective date

15+routine screens listed

Code 87389 addedcoding changes

Coverage and Reimbursement Criteria

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyPrenatal Screening (Nongenetic)

Policy CodePolicy CPCPLAB014

Change TypeRevised (coding updates and clarifications)

Effective DateJan 15, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review and code edit protocols.

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.

inv-01: Routine prenatal screening

Routine prenatal screening tests that may be reimbursable and special-case reimbursable tests.

ALL of the following

Antigen/antibody combination assay screening for HIV infection
Screening for Chlamydia trachomatis infection
Screening for Neisseria gonorrhoeae infection
Triple panel screening (HBsAg, anti-HBs, total anti-HBc) for hepatitis B
Screening for syphilis
Antibody screening for hepatitis C
Screening for type 2 diabetes at the first prenatal visit
Screening for gestational diabetes during gestational weeks 24-28 and at the first prenatal visit if risk factors are present
Determination of blood type, Rh(D) status, and antibody status at the first prenatal visit; repeat Rh(D) antibody testing for unsensitized Rh(D)-negative women at 24-28 weeks unless biological father is Rh(D)-negative
Screening for anemia with a CBC or hemoglobin and hematocrit with mean corpuscular volume
Screening for Group B streptococcal disease once per pregnancy (recommended during gestational weeks 36-37)
Urinalysis and urine culture
Rubella antibody testing
Testing for varicella immunity
Screening for tuberculosis in pregnant individuals deemed to be at high risk for TB

inv-02: Third-trimester re-screening high-risk criteria

Conditions for third-trimester re-screening

ANY of the following

Individual under 25 years of age
New or multiple sexual partners
History of sexually transmitted infections
Past or current injection drug use

inv-03: Nonreimbursable tests

Nonroutine / not reimbursable items

ALL of the following

Human chorionic gonadotropin (hCG) hormone testing for normal pregnancy without complications
Serial monitoring of salivary estriol levels for risk assessment of preterm labor or delivery

inv-04: Symptom-based coverage

Symptom-based reimbursable testing

ANY of the following

Pregnant individuals who present in active labor with undocumented HIV status — Rapid HIV testing may be reimbursable
Pregnant individuals with singleton or twin pregnancies presenting in the ambulatory setting with signs or symptoms of preterm labor — Fetal fibronectin (FFN) assay may be reimbursable

Provider Documentation, Billing, and Authorization

Documentation Required

Documentation and claims review — submit accurate documentation and provide records upon request

Providers must submit accurate documentation of services performed and use valid, industry-standard code combinations when submitting claims. Claims are subject to code edit protocols and claim review; upon request, providers must submit additional documentation to support billed services.

Submit claims using HIPAA‑approved code sets and follow standard coding guidelines (e.g., CPT, HCPCS, ICD‑10).
Claims are subject to code edit protocols, claim review, and verification against benefit coverage, provider contracts, and clinical payment and coding policies.
Provide additional documentation upon request to support medical necessity and billed services.

Prior Authorization

Prior authorization / coverage conditions — symptom‑based tests reimbursable only when criteria met

Certain symptom-driven or time‑sensitive prenatal tests may be reimbursable only when the specific clinical conditions in the policy are met; providers should follow those coverage conditions when ordering and billing these tests.

Rapid HIV testing may be reimbursable for pregnant individuals who present in active labor with an undocumented HIV status.
Fetal fibronectin (FFN) assay may be reimbursable for pregnant individuals with singleton or twin pregnancies presenting in the ambulatory setting with signs and symptoms of preterm labor.

87389	Code added to policy (specific test mapping in document).
83020	Removed code
83021	Removed code
85048	Removed code
86701	Removed code
86702	Removed code
86703	Removed code
G0432	Removed code
G0433	Removed code
G0435	Removed code

OpenPayer

Prenatal Screening (Nongenetic)

Coverage and Reimbursement Criteria

Coding and Test Timing

Provider Documentation, Billing, and Authorization

Definitions and Scope Terms