Immunohistochemistry
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Defines reimbursement coding and unit limits for immunohistochemistry (IHC) laboratory procedures for Blue Cross Blue Shield - Oklahoma; applies to providers billing the Plan for these services.
No material clinical or coverage changes in this revision.
Immunohistochemistry Reimbursement Criteria
IHC reimbursement criteria
Reimbursement and unit limits by CPT code:
IHC procedure code limits
- Code 88342: Use for the first single antibody procedure; reimbursed at 1 unit per specimen, up to 4 specimens per date of service.
- Code 88341: Use for each additional single antibody per specimen; reimbursed up to a maximum of 13 units per date of service.
- Code 88344: Use for each multiplex antibody per specimen; reimbursed up to 6 specimens per date of service.
Procedure Codes and Unit Limits
Documentation, Claims, and Review
Documentation and claim submission
Providers are responsible for submitting accurate documentation and must bill using valid HIPAA-approved code sets; Blue Cross and Blue Shield of Oklahoma may request additional documentation during claim review.
- Submit claims with accurate documentation of services performed.
- Use valid code combinations from HIPAA-approved code sets (e.g., CPT, HCPCS, ICD-10).
- Be prepared to provide additional documentation upon request during claim review.
Claim review and conflicts
Claims are subject to code edit protocols and review against plan terms and provider contracts; when conflicts arise, the applicable plan document or provider contract will govern coverage.
- Claims may be edited or denied based on code edit protocols (e.g., CCI table edits) and coding software logic.
- Coverage determinations are governed by plan documents or provider contracts when conflicts with this policy occur.
Plan Documents and Procedure Code Definitions
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