CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB024

Epithelial Cell Cytology in Breast Cancer Risk Assessment

This Clinical Payment and Coding Policy governs reimbursement for cytologic analysis of epithelial cells to assess breast cancer risk for Blue Cross and Blue Shield of Oklahoma members; providers should consult plan documents for product-specific coverage.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyEpithelial Cell Cytology in Breast Cancer Risk Assessment

Policy CodePolicy CPCPLAB024

Change TypeClarifiedadded and revised prior updates

Effective Date01/03/2026

Next Review Date

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

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review; Reimbursement Information unchanged.

Added codes 88172, 88173, 88177 to the code list and revised reimbursement statement in 03/01/2024 update.

not reimbursableReimbursement stance

5Procedure codes listed

CPCPLAB024Policy identifier

09/26/2025Approval/last review

Coverage Determination

Main coverage statement

Reimbursement and applicability

ALL of the following

Cytologic analysis of epithelial cells to assess breast cancer risk and manage patients at high risk of breast cancer is not reimbursable.

Procedure and Billing Codes

Provider Documentation & Claims Review

Documentation Required

Submit accurate documentation and be prepared for claims review

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyEpithelial Cell Cytology in Breast Cancer Risk Assessment

Policy CodePolicy CPCPLAB024

Change TypeClarifiedadded and revised prior updates

Effective Date01/03/2026

Next Review Date

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.

Plan Documents & Authority

Plan documents and discretionary authority (Definitions)

Governing documentsIf a conflict arises between this Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. Plan documents include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

Provider contract precedenceIf a conflict arises between this CPCP and any provider contract pursuant to which a provider participates in and/or provides Covered Services, the provider contract will govern.

BCBSOK discretionary authorityBlue Cross and Blue Shield of Oklahoma may use reasonable discretion interpreting and applying this policy; BCBSOK has full and final discretionary authority for interpretation and application to the extent provided under any applicable plan documents.

Provider responsibility for documentationProviders are responsible for submission of accurate documentation of services performed and are expected to submit claims using valid code combinations from HIPAA-approved code sets.

Claims review and additional documentationClaims are subject to code edit protocols and claim review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic; upon request providers should submit additional documentation.