CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB038

Urinary Tumor Markers for Bladder Cancer

Defines reimbursement and coding criteria for urinary biomarker tests used in diagnosis and surveillance of bladder cancer for Blue Cross Blue Shield - Oklahoma members and providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyUrinary Tumor Markers for Bladder Cancer

Policy CodePolicy CPCPLAB038

Change TypeCode removals

Effective DateMay 1, 2026

Next Review Date

Key ActionReview plan-specific coverage documents and submit accurate documentation to support claims and code use.

SourceLink

POLICY UPDATE CHANGES

Removed codes 0012M, 0013M, 0363U, 0420U, 0452U, 0465U, 0549U.

3Adjunct reimbursable situations

9Procedure codes listed

1Policy update entries

Coverage Criteria for Urinary Tumor Markers

Reimbursable adjunct uses

Covered when used as adjunct tests in specific clinical contexts.

Adjunct diagnostic or surveillance use: Urinary biomarkers (bladder tumor antigen/BTA, nuclear matrix protein/NMP22, or fluorescence in situ hybridization/FISH UroVysion) are reimbursable when used as an adjunct in either: (a) diagnostic exclusion of bladder cancer for individuals with atypical or equivocal cytology, OR (b) monitoring of high-risk, non–muscle-invasive bladder cancer.

From Reimbursement Information item 1 (a-b).

ImmunoCyt adjunct in surveillance: Fluorescence immunocytology (ImmunoCyt/uCyt) may be reimbursable as an adjunct to cystoscopy or cytology for monitoring individuals with bladder cancer.

From Reimbursement Information item 2.

Not reimbursable / excluded uses

Not reimbursable indications and exclusions.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyUrinary Tumor Markers for Bladder Cancer

Policy CodePolicy CPCPLAB038

Change TypeCode removals

Effective DateMay 1, 2026

Next Review Date

Key ActionReview plan-specific coverage documents and submit accurate documentation to support claims and code use.

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.

Provider Responsibilities and Billing Guidance

Note

Plan/product-specific requirements

The Plan has implemented certain lab management reimbursement criteria. Not all requirements apply to each product; providers should review plan documents for eligible coverage for services rendered.

Not all lab management reimbursement criteria apply to every product — check the member's specific plan documents (e.g., Certificate of Coverage, benefit booklet, Summary Plan Description) to confirm eligibility and coverage.
Blue Cross and Blue Shield of Oklahoma may exercise discretion in interpreting and applying this policy; plan documents and provider contracts govern in case of conflict.

Documentation Required

Documentation and claims accuracy

Providers are responsible for submission of accurate documentation and coding for services rendered. Submit claims using valid, HIPAA-approved code sets and industry coding guidelines.

Use correct CPT/HCPCS/ICD-10/NDC codes and follow coding manuals and CMS guidance (e.g., CCI edits, NCCI, UB, AMA CPT guidance).
Claims are subject to code edit protocols and claim review; providers may be asked to submit additional documentation upon request.

Prior Authorization

Provider action highlight

Submit additional documentation promptly when requested to support medical necessity, coding, or billing. Failure to provide requested records may result in claim denial or recoupment.

Maintain and provide clinical records that justify the test order, indication, and relation to diagnosis or monitoring.
If requested, include cytology/cystoscopy findings, prior pathology, surveillance history, and clinical notes supporting use of urinary biomarker testing.

Denial Risk

Not reimbursable indications (provider-facing)

Tests billed for evaluation of hematuria to screen asymptomatic individuals, to diagnose symptomatic individuals, or for other non-covered indications are not reimbursable.

Urinary biomarkers (BTA, NMP22, UroVysion FISH) and fluorescence immunocytology (ImmunoCyt/uCyt) are not reimbursable when used for hematuria evaluation, asymptomatic screening, diagnosis of symptomatic individuals, or indications other than those expressly allowed.
Any other urinary tumor markers for bladder cancer not specifically listed as reimbursable are also not reimbursable.

Background

Urinary biomarkers (for example, bladder tumor antigen/BTA, nuclear matrix protein/NMP22, and UroVysion FISH) and fluorescence immunocytology (ImmunoCyt/uCyt) are adjunct tools used to aid in the diagnosis or surveillance of bladder cancer. Per the policy, these assays may be reimbursable when used as an adjunct to cytology—specifically to help exclude cancer in patients with atypical or equivocal cytology—or as adjuncts in monitoring individuals with high‑risk, non–muscle‑invasive bladder cancer, and ImmunoCyt may be used adjunctively with cystoscopy or cytology in surveillance.

Definitions

Inv-11: Urinary biomarkers — definitions

Bladder Tumor Antigen (BTA)A urinary biomarker test (BTA) referenced as reimbursable when used as an adjunct in diagnostic exclusion of bladder cancer or monitoring high‑risk non–muscle‑invasive disease; listed among tests not reimbursable for hematuria evaluation, asymptomatic screening, or other unlisted indications.

Nuclear Matrix Protein 22 (NMP22)A urinary protein marker (NMP22) used as an adjunctive test for diagnostic exclusion in cases of atypical/equivocal cytology or for surveillance of high‑risk non–muscle‑invasive bladder cancer; not reimbursable for hematuria evaluation, asymptomatic screening, diagnosis of symptomatic individuals, or other unlisted uses.

UroVysion (FISH) Bladder Cancer testA fluorescence in situ hybridization (FISH) assay (UroVysion) cited as an adjunct reimbursable test for diagnostic exclusion with atypical cytology or monitoring high‑risk non‑muscle‑invasive bladder cancer; excluded for hematuria evaluation, asymptomatic screening, symptomatic diagnosis, and other unlisted indications.

Fluorescence Immunocytology (ImmunoCyt/uCyt)An immunocytology assay that may be reimbursable as an adjunct to cystoscopy or cytology in monitoring individuals with bladder cancer; not reimbursable for hematuria evaluation, screening asymptomatic individuals, diagnosing symptomatic individuals, or other unlisted indications.

Other urinary tumor markersAny urinary tumor markers for bladder cancer not specifically named (BTA, NMP22, UroVysion, ImmunoCyt) are stated as not reimbursable.

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0365U
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0367U

OpenPayer

Urinary Tumor Markers for Bladder Cancer

Coverage Criteria for Urinary Tumor Markers

Procedure and Billing Codes

Provider Responsibilities and Billing Guidance

Background

Definitions