CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB033

Diagnostic Testing of Influenza

This policy governs reimbursement criteria for laboratory diagnostic testing for influenza for Blue Cross Blue Shield - Oklahoma members and applies to providers submitting claims for influenza testing.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiagnostic Testing of Influenza

Policy CodePolicy CPCPLAB033

Change TypeRevisedRemovedClarified

Effective DateSep 26, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request for claims review.

SourceLink

POLICY UPDATE CHANGES

Edited reimbursement criteria for symptomatic individuals for clarity and added reference to a new billing Note 2 allowing up to two units when both influenza A and B are detected by certain CPT codes.

Removed CPT code 87631 from the procedure code list.

Updated Note 1 with signs and symptoms of influenza to align with CDC guidance.

1influenza test reimbursable per symptomatic individual

0Viral culture tests reimbursable

0Influenza testing reimbursable for asymptomatic patients

0Serology testing reimbursable

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiagnostic Testing of Influenza

Policy CodePolicy CPCPLAB033

Change TypeRevisedRemovedClarified

Effective DateSep 26, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request for claims review.

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.

Influenza Testing Coverage Criteria

Influenza testing reimbursement criteria

Reimbursement determinations for influenza testing are based on symptoms and test type.

ALL of the following

ONE of the following may be reimbursable
- One single rapid flu test
  Either a point-of-care rapid NAAT or a rapid antigen test (only one test per symptomatic visit is reimbursable).
- One single traditional NAAT
  Only one test per symptomatic visit is reimbursable.

ALL of the following

Viral culture testing for influenza is not reimbursable.

ALL of the following

Influenza testing for asymptomatic patients is not reimbursable (includes rapid antigen, rapid NAAT or RT-PCR, traditional RT-PCR, and viral culture).

ALL of the following

Serology testing for influenza is not reimbursable.

ALL of the following

When a single test detects both influenza A and B (tests represented by CPT codes 87400, 87501, or 87804), up to two units may be billed at a single visit.
Applies only when both A and B are detected by a single test represented by the listed CPT codes.

Representative CPT Codes and Billing Notes

Representative CPT codes referenced in policyCPT

87400	Influenza A and B test (as referenced for billing up to two units when both A and B detected)
87501	Influenza test (referenced for billing up to two units when both A and B detected)
87804	Influenza test (referenced for billing up to two units when both A and detected)

Note on removed codesCPT

87631

Removed from procedure code list (no longer included)

inv-03: Units allowed when both A and B detected

Billing allowanceWhen a single test detects both influenza A and B (tests represented by CPT codes 87400, 87501, or 87804), up to 2 units may be billed at a single visit.

Applicable CPT codesCPT 87400, CPT 87501, CPT 87804 (tests referenced for the dual-detection billing allowance)

Unit scopeAllowance applies only when one test detects both influenza A and B; does not change the one-test-per-symptomatic-visit reimbursement rule for other scenarios.

Documentation and Claim Review Requirements

Documentation Required

Documentation and claim review — submit accurate documentation and respond to requests

Providers must submit accurate documentation of services performed and code claims using valid, industry-standard code sets and combinations. Claims are reviewed against benefit coverage, provider contracts, medical and coding policies, and code edit protocols; upon request, providers should submit any additional documentation to support the claim.

Submit claims using valid HIPAA-approved code sets and appropriate code combinations (CPT, HCPCS, ICD-10, etc.).
Claims are subject to code edit protocols and review for benefit coverage, provider contract terms, medical and coding policies, and coding software logic.
If requested, promptly provide additional documentation to support the claim.

Key Definitions

inv-05: Typical influenza signs and symptoms

Fever or chillsFever or feeling feverish/chills

Respiratory symptomsCough; sore throat; runny or stuffy nose

Systemic symptomsHeadaches; muscle or body aches; fatigue

Gastrointestinal symptoms (children)Vomiting and/or diarrhea (more common in children than adults)

inv-06: Plan documents

Certificates of Health Care BenefitsFormal plan documents that describe covered services and member entitlements and govern benefits when conflicts with policy arise.

Benefit booklets