CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO59

Diagnosis of Vaginitis (laboratory testing and reimbursement)

Defines reimbursement criteria and coding guidance for laboratory testing used to diagnose vaginitis for BCBS Oklahoma members; applies to providers submitting claims for such testing under applicable plan documents.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiagnosis of Vaginitis (laboratory testing and reimbursement)

Policy CodePolicy CPCPLABO59

Change TypeMaterial and non-material edits

Effective DateAug 8, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to plan, contract, medical policy and coding review.

SourceLink

POLICY UPDATE CHANGES

Added "measurement of sialidase activity" to Reimbursement Information item #1.

Changed wording from "hydrogen peroxide" to "potassium hydroxide" in Reimbursement Information item #1.

Added procedure code O505U.

NAAT panel testing designed to detect multiple vaginitis causes (VVC, BV, trichomoniasis) may be reimbursable (BD MAX Vaginal Panel, NuSwab VG, Xpert Xpress MVP).

12reimbursement statements

14references cited

~20procedure codes

2025-04-28last approval

Coverage Criteria for Vaginitis Testing

Coverage criteria

Reimbursement guidance for individuals with signs/symptoms or asymptomatic status:

ALL of the following

pH testing
testing for the presence of amines (whiff test)
measurement of sialidase activity
saline wet mount
potassium hydroxide (KOH) wet mount

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiagnosis of Vaginitis (laboratory testing and reimbursement)

Policy CodePolicy CPCPLABO59

Change TypeMaterial and non-material edits

Effective DateAug 8, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to plan, contract, medical policy and coding review.

SourceLink

On This Page

ALL of the following

Direct probe DNA–based identification of Gardnerella, Trichomonas, and Candida (e.g., BD Affirm VPIII)
NAAT or PCR–based identification of Trichomonas vaginalis
For symptomatic individuals with signs of BV, NAAT specific to BV (e.g., Aptima BV, OneSwab BV Panel with lactobacillus profiling, SureSwab Advanced BV TMA) and single or multitarget PCR testing for BV
For symptomatic individuals, NAAT testing designed to detect more than one type of vaginitis (VVC, BV, and/or trichomoniasis; e.g., BD MAX Vaginal Panel, NuSwab VG, Xpert Xpress MVP)

ALL of the following

For symptomatic individuals with negative wet-mount findings and a normal pH, vaginal cultures for Candida species for diagnosis of vulvovaginal candidiasis
For individuals with complicated or recurrent vulvovaginal candidiasis, PCR–based identification of Candida to confirm diagnosis and identify non‑albicans species
Screening for Trichomonas may be reimbursable for individuals with risk factors (new or multiple partners; history of STIs, especially HIV; exchange of sex for payment; incarceration; or injection drug use)

Procedure Codes and Coding Guidance

Listed procedure codes (not exhaustive)mixed

81513
81514
81515
82120
83986
87070
87149
87150
87210
87480

1–10 of 16

1/2

Coding caveats and limitations

Code inclusion caveatThe inclusion of a code in the procedure list is not an all-encompassing code list; inclusion does not guarantee it is a covered service or eligible for reimbursement.

Coding guidance applies to standard code setsClaims should be submitted using valid code combinations from HIPAA-approved code sets (CPT, HCPCS, ICD-10, etc.) and coded per industry standard guidelines.

Claims subject to reviewClaim submissions are subject to claim review, including plan benefit terms, provider contract language, medical policies, coding policies, and coding software logic.

Provider documentation responsibilityProviders are responsible for submission of accurate documentation and may be asked to submit additional documentation upon request.

Documentation, Claims, and Provider Responsibilities

Documentation Required

Documentation, coding, and claim review requirements

Providers must submit accurate documentation of services performed and code claims using valid HIPAA-approved code sets and industry standard coding guidelines. Claims are subject to claim review for benefit coverage, provider contract terms, medical policies, clinical payment and coding policies, and coding software logic; upon request providers must submit additional documentation.

Submit claims using valid code combinations from HIPAA-approved code sets (e.g., CPT, HCPCS, ICD-10).
Code according to industry standard coding guidelines (Uniform Billing, AMA CPT Assistant, CMS NCCI, etc.).
Be prepared to provide additional documentation upon request to support medical necessity and coding.

Definitions and Reimbursable Testing

Plan documents (definition and governance)

Definition of 'Plan documents''Plan documents' include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

Governing authority in conflictIf a conflict exists 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.

Provider contract precedenceIf a conflict exists between this CPCP and a provider contract, the provider contract will govern for participating providers.

BCBSOK discretionBlue Cross and Blue Shield of Oklahoma may use reasonable discretion interpreting and applying this policy to services delivered in a particular case.

Reimbursable testing (symptomatic vaginitis)

Reimbursable tests for symptomatic individualsWet mount (saline) and potassium hydroxide/KOH wet mount; pH testing; testing for presence of amines; measurement of sialidase activity; and microscopic examination of vaginal fluids may be reimbursable for individuals with signs and symptoms of vaginitis.

NAAT/NAAT panels and PCRNAAT or PCR-based testing for Trichomonas vaginalis, NAAT specific to BV (e.g., Aptima BV, OneSwab BV Panel, SureSwab Advanced BV TMA), and multi-target NAAT panels (e.g., BD MAX Vaginal Panel, NuSwab VG, Xpert Xpress MVP) may be reimbursable for symptomatic individuals.

Probe DNA-based identification and culturesDirect probe DNA-based identification (e.g., BD Affirm VPIII) and vaginal cultures for Candida species (when wet mount is negative and pH is normal) may be reimbursable for symptomatic individuals.

PCR for complicated CandidaFor complicated vulvovaginal candidiasis, PCR-based identification of Candida to confirm diagnosis and identify non-albicans species may be reimbursable.