CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB048

Folate Testing

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Rules for reimbursement of laboratory folate testing (serum folate, RBC folate, and folate receptor autoantibody testing) for Blue Cross Blue Shield - Oklahoma members and providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyFolate Testing

Policy CodePolicy CPCPLAB048

Change TypeMaterial clinical updates (revised reimbursable situationsadded exclusion reaffirmation)

Effective DateNov 7, 2025

Last ReviewJul 25, 2025

Next Review Date

Key ActionSubmit documentation showing the indication meets reimbursable situations (megaloblastic/macrocytic anemia or bariatric procedure management) to support serum folate testing claims.

SourceLink

POLICY UPDATE CHANGES

Measurement of serum folate concentration may be reimbursable for individuals with megaloblastic or macrocytic anemia and for individuals who have undergone or are scheduled for bariatric procedures.

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

3distinct reimbursement rules listed

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CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB048

Folate Testing

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Oklahoma Policy CPCPLAB048 alerts

Get alerted when Policy CPCPLAB048 changes without checking for updates manually.

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Rules for reimbursement of laboratory folate testing (serum folate, RBC folate, and folate receptor autoantibody testing) for Blue Cross Blue Shield - Oklahoma members and providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyFolate Testing

Policy CodePolicy CPCPLAB048

Change TypeMaterial clinical updates (revised reimbursable situationsadded exclusion reaffirmation)

Effective DateNov 7, 2025

Last ReviewJul 25, 2025

Next Review Date

Key ActionSubmit documentation showing the indication meets reimbursable situations (megaloblastic/macrocytic anemia or bariatric procedure management) to support serum folate testing claims.

SourceLink

POLICY UPDATE CHANGES

Measurement of serum folate concentration may be reimbursable for individuals with megaloblastic or macrocytic anemia and for individuals who have undergone or are scheduled for bariatric procedures.

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

3distinct reimbursement rules listed

Coverage Criteria

inv-01: Reimbursable: Serum folate

Measurement of serum folate concentration is reimbursable when ANY of the following apply:

Reimbursable serum folate indications: a) For individuals with megaloblastic anemia or macrocytic anemia; b) For individuals who have undergone, or for those who have been scheduled for, bariatric procedures such as Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion/duodenal switch.

Updated to allow serum folate testing for these indications.

inv-02: Not reimbursable: RBC folate

Not reimbursable tests: Measurement of red blood cell (RBC) folate is not reimbursable.

Explicit exclusion.

inv-03: Not reimbursable: Folate receptor autoantibody

Not reimbursable tests: Folate receptor autoantibody testing is not reimbursable for all situations.

Added in prior updates; remains not reimbursable.

Measurement of red blood cell (RBC) folate and folate receptor autoantibody testing are excluded from reimbursement. The policy explicitly states that RBC folate is not reimbursable for any indication and that folate receptor autoantibody testing is not reimbursable in all situations.

Measurement of serum folate is reimbursable only for the specific situations listed in this policy (individuals with megaloblastic or macrocytic anemia and individuals who have undergone or are scheduled for specified bariatric procedures); for all other indications, serum folate measurement is not reimbursable.

Covered Indications

inv-14: Megaloblastic anemia or macrocytic anemia

Serum folate measurement may be reimbursable when the following clinical condition is present:

Megaloblastic or macrocytic anemia: Clinical evidence of megaloblastic anemia or macrocytic anemia (enlarged red blood cells, often associated with vitamin B12 or folate deficiency).

See definitions for clinical context; serum folate measurement may be reimbursable for this indication.

inv-15: Patients who have undergone or are scheduled for bariatric procedures

Serum folate measurement may be reimbursable for individuals who have undergone or are scheduled for specific bariatric procedures:

Bariatric procedures: Individuals who have undergone, or who are scheduled for, bariatric procedures such as Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion/duodenal switch.

Serum folate measurement may be reimbursable for peri- or post-operative management in these patients.

Coding

Codes listed in policyCPT

82746	Folate; serum
82747	Folate; RBC
0399U	Folate receptor autoantibody

Provider Actions

Prior Authorization

Plan-specific prior authorization

Not all requirements apply to every BCBSOK product. Providers must review the member's specific plan documents (for example, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions) and any applicable provider contract to determine product-specific coverage and prior authorization rules; plan documents will govern in the event of a conflict with this policy.

Note

Verify plan-specific coverage

Providers should verify product-specific coverage and prior authorization requirements in plan documents and applicable provider contracts before ordering testing; the plan document or provider contract governs if there is a conflict with this policy.

Documentation Required

Definitions

inv-12: Megaloblastic or macrocytic anemia — definition and relevance as a reimbursable indication

DefinitionAnemias characterized by enlarged red blood cells often associated with vitamin B12 or folate deficiency; listed as a reimbursable indication for serum folate measurement.

Reimbursable relevanceMeasurement of serum folate concentration may be reimbursable for individuals with megaloblastic anemia or macrocytic anemia.

Clinical contextThese anemia types are cited as targeted indications because routine folate testing is less necessary in folic-acid fortified populations; guidance and literature were reviewed in the policy update.

inv-13: Bariatric procedures — examples (Roux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion/duodenal switch) and coverage context

ExamplesRoux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion/duodenal switch.

Frequency Limits

inv-16: Frequency limits placeholder (inventory had no label or content; writer should pull full-source fallback)

Frequency limits statedNo specific frequency limits are defined in the policy for serum folate testing (frequency section contains no limit or period).

Implication for orderingProviders should follow clinical judgment and any product-specific plan rules; verify plan documents for applicable frequency or prior authorization requirements.

Related exclusionsRBC folate and folate receptor autoantibody tests are not reimbursable regardless of frequency.

Ordering Requirements

Note

Ordering and plan verification

Verify product-specific coverage, ordering rules, and any prior authorization requirements in the member’s plan documents before ordering folate testing; submit supporting documentation to justify the reimbursable indication when requested.

Check the member’s Certificate of Benefits or Summary Plan Description for applicable coverage rules.
Provide clinical justification when ordering serum folate (CPT 82746) for reimbursable indications.

Not Covered

Red blood cell (RBC) folate testing (CPT 82747) and folate receptor autoantibody testing (CPT 0399U) are not reimbursable under this policy for any indication or situation.

Background

Folate status is assessed when folate deficiency or certain anemias are suspected. Historically, both serum folate and RBC folate assays have been used to evaluate folate stores; current policy limits reimbursable serum folate testing to targeted clinical contexts (notably macrocytic/megaloblastic anemia and peri-/post-bariatric procedure management) and excludes RBC folate and folate receptor autoantibody testing.