ModifiedBlue Cross Blue Shield - OklahomaPolicy CPCPLAB051

Diagnostic Testing of Common Sexually Transmitted Infections

Reimbursement and coding criteria for laboratory testing of selected STIs (C. trachomatis, N. gonorrhoeae, T. pallidum, T. vaginalis, HSV, and HPV) for Blue Cross Blue Shield of Oklahoma members and participating providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiagnostic Testing of Common Sexually Transmitted Infections

Policy CodePolicy CPCPLAB051

Change TypeMaterial addition + clarifying revisions

Effective DateNovember 1, 2023

Next Review DateN/A

Key ActionReimburse multitarget PCR for CT/NG when the member meets clinical conditions for both chlamydia and gonorrhea.

SourceLink

POLICY UPDATE CHANGES

Added #10: When an individual meets the conditions described above for both chlamydia and gonorrhea, multitarget PCR testing (targets limited to C. trachomatis and N. gonorrhoeae) may be reimbursable.

Reimbursement information revised for clarity.

Document updated with literature review; references revised (some added, others removed).

1.0policy version

Nov 1, 2023plan effective

1multitarget PCR addition

6pathogen groups

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.

procedure codes listed

Coverage Criteria by Organism and Test Type

Organism-specific coverage criteria

Reimbursement criteria, organized by organism and test type. Covered when the specific conditions listed for each test and organism are met.

Treponema pallidum (syphilis)

Antibody testing (treponemal + nontreponemal) may be reimbursable when: a) asymptomatic person in a high-risk category — once yearly using a standard or reverse algorithm including initial and confirmatory tests; OR b) once every three months for HIV-positive men or men who have sex with men (MSM); OR c) diagnosis of a person with signs/symptoms of syphilis; OR d) when a nontreponemal test is used as a test of cure (TOC).

Chlamydia trachomatis

NAATs may be reimbursable when: a) once a year assessment for asymptomatic persons in a high-risk category; OR b) diagnosis of symptomatic persons; OR c) diagnosis of suspected lymphogranuloma venereum (LGV); OR d) test of cure at least three months after initial diagnosis.
Serology testing for chlamydia or LGV is not reimbursable.

Neisseria gonorrhoeae

NAATs may be reimbursable when: a) once a year assessment for asymptomatic persons in a high-risk category; OR b) diagnosis of symptomatic persons; OR c) as a test of cure after treatment.
Culture may be reimbursable for antimicrobial susceptibility testing when a patient does not respond to initial treatment.

Trichomonas vaginalis

NAAT/PCR testing may be reimbursable for symptomatic individuals or for asymptomatic individuals in high-risk groups (including concurrent STI/history of STIs, individuals in high-prevalence settings, and individuals who exchange sex for payment).
Rapid enzyme immunoassay identification for Trichomonas is not reimbursable.

Herpes Simplex Virus (HSV)

NAAT/PCR for HSV-1 or HSV-2 may be reimbursable for individuals with active genital ulcers or mucocutaneous lesions.
Nonspecific immunoassay testing for HSV-1/HSV-2 is not reimbursable.
Type-specific serologic testing for HSV-2 (gG2) may be reimbursable when: recurrent or atypical genital symptoms or lesions with negative HSV PCR/culture; OR clinical diagnosis of genital herpes with negative PCR/culture or without lab confirmation; OR patient’s partner has genital herpes.

Human Papillomavirus (HPV)

HR-HPV NAAT or p16 IHC may be reimbursable for diagnosis or assessment of cancer or cancer therapy.
NAAT screening for oncogenic HPV types as part of general STI/STD panels for asymptomatic patients, testing for anogenital warts, screening for low-risk types, or general population HPV status testing is not reimbursable.

PrEP-related screening

HIV antibody screening, baseline renal function (serum creatinine and estimated creatinine clearance), HBV/HCV screening, pregnancy testing, and baseline/periodic STI screening per CDC guidelines may be reimbursable prior to and during PrEP as specified (HIV antibody and NAAT screening schedules by anatomic site and risk groups are detailed in policy).

Non-reimbursable uses

Using nucleic acid testing/NAAT to quantify Chlamydia trachomatis, Neisseria gonorrhoeae, HSV-1, HSV-2, HPV, or Treponema pallidum is not reimbursable.

Multitarget PCR reimbursement criteria

Specific reimbursement condition added in the policy update history:

When an individual meets the conditions described above for both chlamydia and gonorrhea, multitarget PCR testing (targets limited to C. trachomatis and N. gonorrhoeae) may be reimbursable.

Applies only when member meets the clinical conditions for both CT and NG testing elsewhere in this policy.

Procedure and CPT/HCPCS Coding

Example procedure/CPT/HCPCS codes listedmixed

82565
82575
84702
84703
86592
86593
86631
86632
86694
86695

1–10 of 60

1/6

Multitarget CT/NG PCR testingmixedCovered

No codes listed

Multitarget CT/NG PCR testingmixedCovered

No codes listed

Documentation, Claims, and Billing Actions for Providers

Documentation Required

Submit accurate documentation and respond to requests for additional documentation

Providers are responsible for submission of accurate documentation of services performed and must code claims using valid HIPAA-approved code sets and standard coding guidelines. Claims are subject to review against benefit coverage, provider contracts, medical and coding policies, code edit protocols and coding software logic; upon request, providers should submit any additional documentation.

Submit claims using HIPAA-approved code sets (CPT, HCPCS, ICD-10, etc.) and industry standard coding guidance.
Claims are subject to code edit protocols and claim review including benefit coverage, provider contract, medical and payment/coding policies.
Provide additional documentation upon request to support services billed.

Definitions and Key Terms

Plan documents / BCBSOK discretion

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

Conflict resolution governing documentsIf a conflict exists between a Payment and Coding Policy and a plan document under which a member is entitled to Covered Services, the plan document governs.

Provider contract precedenceIf a conflict exists between a Payment and Coding Policy and a provider contract, the provider contract governs for services provided under that contract.

BCBSOK discretionBCBSOK may use reasonable discretion in interpreting and applying this policy to services being delivered in a particular case and has full and final discretionary authority for interpretation and application to the extent provided under any applicable plan documents.

Provider responsibilityProviders must submit accurate documentation and use valid HIPAA‑approved code sets; claims are subject to review and providers may be asked to submit additional documentation.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiagnostic Testing of Common Sexually Transmitted Infections

Policy CodePolicy CPCPLAB051

Change TypeMaterial addition + clarifying revisions

Effective DateNovember 1, 2023

Next Review DateN/A

Key ActionReimburse multitarget PCR for CT/NG when the member meets clinical conditions for both chlamydia and gonorrhea.

SourceLink

On This Page

Reimbursable multitarget PCR only when clinical criteria for both CT and NG are met

When a patient meets the policy criteria for both chlamydia and gonorrhea testing, reimbursement may be allowed for a multitarget PCR that includes only C. trachomatis and N. gonorrhoeae targets.

Multitarget PCR reimbursement is limited to assays targeting C. trachomatis and N. gonorrhoeae.
Member must meet the clinical conditions for both CT and NG testing as described elsewhere in the policy for reimbursement to apply.

High-risk screening

High-risk groups (CDC-sourced)Asymptomatic persons in high‑risk categories and HIV‑positive men or men who have sex with men (MSM) are specifically identified for more frequent screening; see policy notes referencing CDC guidance.

Syphilis screening frequencyOnce a year for asymptomatic persons in a high‑risk category; once every three months for HIV‑positive men or MSM; also for symptomatic individuals and as test-of-cure when nontreponemal tests used.

Chlamydia & gonorrhea screening frequencyOnce a year for asymptomatic persons in a high‑risk category; symptomatic testing as indicated; test-of-cure for chlamydia at least three months after diagnosis; special schedules for PrEP and MSM described elsewhere in policy.

PrEP and MSM interval guidanceFor individuals on PrEP and MSM, NAAT STI screening intervals include assessments every 3 months for some groups (policy references CDC-based frequency recommendations).

Multitarget PCR testing

Definition of multitarget PCR testingPCR-based assays that detect both Chlamydia trachomatis and Neisseria gonorrhoeae targets in a single test (targets limited to C. trachomatis and N. gonorrhoeae as described in the policy).

Reimbursement conditionMultitarget PCR testing may be reimbursable when an individual meets the policy conditions for both chlamydia and gonorrhea testing.

Examples / device referencesPolicy references FDA-cleared assays (e.g., Xpert CT/NG) and manufacturer datasheets as supporting materials for multitarget CT/NG PCR assays.

Scope limitationMultitarget testing reimbursement is limited to targets for C. trachomatis and N. gonorrhoeae and applies only when clinical criteria for both organisms are met.