CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO31

Measurement of Thromboxane Metabolites for ASA Resistance

This reimbursement policy governs whether measurement of thromboxane metabolites in urine (e.g., AspirinWorks) to evaluate aspirin resistance is reimbursable under BCBSOK products; applicability may vary by specific plan documents and provider contracts.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyMeasurement of Thromboxane Metabolites for ASA Resistance

Policy CodePolicy CPCPLABO31

Change TypeNo material change

Effective DateNov 1, 2022

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not reimbursablecoverage stance

2 listedprocedure codes

11/01/2022policy start

Coverage Criteria

Coverage for thromboxane metabolite testing

General reimbursement stance and applicability

Not covered: The measurement of thromboxane metabolites in urine (e.g., AspirinWorks) to evaluate aspirin resistance is not reimbursable for all indications.

Applicability: Not all lab management reimbursement requirements apply to each product; providers should review the member's plan documents and provider contract for eligible coverage.

Coding and Reimbursement Details

Procedure codes listed in policyCPT

82570	Drug assay/drug screen
84431	Thyroid stimulating hormone (example description, code listed in policy)

Reimbursement limitation

Reimbursement status

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyMeasurement of Thromboxane Metabolites for ASA Resistance

Policy CodePolicy CPCPLABO31

Change TypeNo material change

Effective DateNov 1, 2022

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

On This Page

Provider Actions and Billing Guidance

Documentation Required

Documentation and claims review

Providers are responsible for submission of accurate documentation of services performed. Providers are expected to submit claims for services rendered using valid code combinations from HIPAA-approved code sets and to code claims appropriately according to industry-standard coding guidelines (including but not limited to UB Editor, AMA CPT, CPT Assistant, HCPCS, ICD-10 CM/PCS, NDC, DRG guidelines, CMS NCCI Policy Manual and CCI table edits). Claims are subject to code edit protocols and claim review, which may include review of benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. Upon request, providers should submit any additional documentation to support the claim.

Affected code sets: CPT, HCPCS, ICD-10, NDC, DRG
Claims may be adjusted or denied if documentation or coding is incomplete or inconsistent
Providers may be asked to provide supporting records during claims review

Billing Rule

Plan document precedence

If a conflict arises between a Clinical Payment and Coding Policy ("CPCP") and any plan document under which a member is entitled to Covered Services, the plan document will govern. If a conflict arises between a CPCP and any provider contract pursuant to which a provider participates in and/or provides Covered Services to eligible member(s) and/or plans, the provider contract will govern. "Plan documents" include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents. BCBSOK may use reasonable discretion interpreting and applying this policy to services delivered in a particular case; BCBSOK has full and final discretionary authority for their interpretation and application to the extent provided under any applicable plan documents.

Plan documents supersede this policy when there is a conflict
Provider contracts supersede this policy when there is a conflict with a CPCP
Examples of plan documents: Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions

OpenPayer

Measurement of Thromboxane Metabolites for ASA Resistance

Coverage Criteria

Coding and Reimbursement Details

Provider Actions and Billing Guidance

Definitions