CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO28

Immune Cell Function Assay reimbursement

Defines BCBSOK reimbursement stance and coding guidance for immune cell function assays (laboratory tests used to monitor/predict immune function), and describes indications that may or may not be reimbursable for members covered by BCBSOK plans.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyImmune Cell Function Assay reimbursement

Policy CodePolicy CPCPLABO28

Change TypeNo material changes

Effective DateNov 1, 2023

Next Review Date

Key ActionSubmit accurate documentation and use valid HIPAA-approved code sets; be prepared to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3procedure codes listed

1primary reimbursable indication

7+non-reimbursable examples

1policy review note

Reimbursable and Non-reimbursable Indications

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyImmune Cell Function Assay reimbursement

Policy CodePolicy CPCPLABO28

Change TypeNo material changes

Effective DateNov 1, 2023

Next Review Date

Key ActionSubmit accurate documentation and use valid HIPAA-approved code sets; be prepared to provide additional documentation upon request.

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.

Use of an immune cell function assay to monitor and predict immune function after solid organ transplantation may be reimbursable.

Not reimbursable for the following indications (examples)

Management of immunodeficiency disorders, including human immunodeficiency virus (HIV) and severe combined immunodeficiency disease (SCID).
Management of autologous or allogeneic hematopoietic stem cell transplantation.
Management of or prediction of infection risk in immune-mediated disorders, including rheumatoid arthritis (RA), multiple sclerosis (MS), and lupus nephritis.
Testing for urticaria.
Diagnosis and management of Lyme disease (for example, iSpot Lyme Test).
Monitoring immune response following surgery.
Management of inflammatory bowel diseases.

Documentation, Claims & Review Requirements

Documentation Required

Documentation & Plan Governance

If a conflict arises between this Clinical Payment and Coding Policy (CPCP) and any plan document under which a member is entitled to Covered Services, the plan document governs. If a conflict arises between this 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 governs. "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 being delivered in a particular case. BCBSOK has full and final discretionary authority for interpretation and application to the extent provided under any applicable plan documents.

Providers must submit claims using valid code combinations from HIPAA‑approved code sets.
Code sets include but are not limited to: UB, AMA/CPT, CPT Assistant, HCPCS, ICD‑10 CM/PCS, NDC, DRG guidelines, CMS NCCI Policy Manual and CCI table edits.

Billing Rule

Claim Review & Edit Protocols

Claims are subject to review and coding edit protocols. Claim submissions may be reviewed for benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. Upon request, providers must submit additional documentation to support billed services.

Claims may be denied or adjusted if coding, modifiers, or documentation do not support billed services.
Providers are expected to code appropriately following industry standard coding guidelines to avoid edits and denials.

OpenPayer

Immune Cell Function Assay reimbursement

Reimbursable and Non-reimbursable Indications

Procedure Codes

Documentation, Claims & Review Requirements

Key Definitions

81560
86352
0018M