CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB038

Urinary Tumor Markers for Bladder Cancer

Defines reimbursement criteria for urinary tumor marker laboratory tests used in the diagnosis and surveillance of bladder cancer for Blue Cross Blue Shield - New Mexico members and participating providers.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyUrinary Tumor Markers for Bladder Cancer

Policy CodePolicy CPCPLAB038

Change TypeLiterature reviewcode additions

Effective DateAug 8, 2025

Next Review Date

Key ActionSubmit accurate documentation and bill using valid HIPAA code sets; claims may be reviewed against plan documents and provider contracts.

SourceLink

POLICY UPDATE CHANGES

Added code 0452U.

Added code 0549U.

Added codes 0420U and 0465U.

Document updated with literature review.

3situations reimbursable

4not reimbursable tests

4recent update entries

1.0policy version

Reimbursement Criteria

Reimbursement criteria for urinary tumor markers

Covered when the following criteria are met:

ANY of the following

ALL of the following
- Urinary biomarkers (BTA, NMP22, UroVysion FISH) as an adjunct in the diagnostic exclusion of bladder cancer for individuals who have an atypical or equivocal cytology.
ALL of the following
- Urinary biomarkers (BTA, NMP22, UroVysion FISH) as an adjunct in the monitoring of high-risk, non-muscle invasive bladder cancer.
ALL of the following

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyUrinary Tumor Markers for Bladder Cancer

Policy CodePolicy CPCPLAB038

Change TypeLiterature reviewcode additions

Effective DateAug 8, 2025

Next Review Date

Key ActionSubmit accurate documentation and bill using valid HIPAA code sets; claims may be reviewed against plan documents and provider contracts.

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.

Documentation & Claims Submission

Documentation Required

Documentation, coding and claims submission requirements

Providers must submit accurate documentation of services performed and submit claims using valid HIPAA-approved code sets. Claims should be coded according to industry-standard coding guidelines (for example: Uniform Billing, AMA CPT, CPT Assistant, HCPCS, ICD‑10‑CM/PCS, NDCs, DRG guidelines, CMS NCCI policy/manual and table edits). Claims are subject to code edit protocols and review against plan documents, provider contracts, medical and coding policies; upon request, providers should supply any additional documentation.

Submit claims using valid code combinations from HIPAA‑approved code sets.
Code claims per industry standards including CPT, HCPCS, ICD‑10, NDC, DRG, and NCCI guidelines.
Be prepared to provide additional documentation upon request during claim review.

Key Definitions

Urinary biomarkers — definitions

BTA (Bladder Tumor Antigen)A urinary biomarker test (bladder tumor antigen) used to detect antigen associated with bladder cancer; may be reimbursable as an adjunct in diagnostic exclusion for atypical/equivocal cytology or for monitoring high‑risk, non‑muscle invasive bladder cancer.

NMP22 (Nuclear Matrix Protein 22)A urinary biomarker assay that detects nuclear matrix protein associated with urothelial carcinoma; may be reimbursable as an adjunct in diagnostic exclusion for atypical/equivocal cytology or for monitoring high‑risk, non‑muscle invasive bladder cancer.

UroVysion FISH (fluorescence in situ hybridization)A urine‑based FISH test (UroVysion) that detects chromosomal abnormalities in bladder cancer cells; may be reimbursable as an adjunct in diagnostic exclusion for atypical/equivocal cytology or for monitoring high‑risk, non‑muscle invasive bladder cancer.

Fluorescence immunocytology (ImmunoCyt/uCyt)

Fluorescence immunocytology (ImmunoCyt/uCyt)A urine immunocytology assay using fluorescently labeled antibodies (ImmunoCyt/uCyt) used as an adjunct to cystoscopy or cytology for monitoring individuals with bladder cancer; may be reimbursable only as an adjunct to cystoscopy or cytology.

Typical roleAdjunctive test to improve detection/monitoring sensitivity when used alongside cystoscopy or cytology in patients with known bladder cancer.

LimitationsNot reimbursable for evaluation of hematuria, screening of asymptomatic individuals, diagnosing symptomatic individuals, or other indications not expressly listed.

OpenPayer

Urinary Tumor Markers for Bladder Cancer

Reimbursement Criteria

Codes and Billing

Documentation & Claims Submission

Key Definitions

0420U	code referenced in update history
0465U	code referenced in update history
0452U	code referenced in update history
0549U	code referenced in update history