ModifiedBlue Cross Blue Shield - OklahomaPolicy CPCPLAB059

Diagnosis of Vaginitis (laboratory testing reimbursement & coding)

Reimbursement and coding guidance for laboratory testing used to diagnose vaginitis, describing which tests may or may not be reimbursable for individuals with signs/symptoms or for asymptomatic screening; applies to providers submitting claims to BCBSOK.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDiagnosis of Vaginitis

Policy CodePolicy CPCPLAB059

Change TypeCoding and coverage criteria updates (material)

Effective DateAugust 8, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and bill using the updated lab codes (e.g., 81515, 0505U) per the policy effective date.

SourceLink

POLICY UPDATE CHANGES

Added 'measurement of sialidase activity' to #1, resulting in deletion of #4.

Changed 'hydrogen peroxide' to 'potassium hydroxide' in #1.

Added code 81515 and deleted code 0352U.

Added code 0505U on 10/30/2024.

Revised #9 from 'is not reimbursable' to 'may be reimbursable' to state that NAAT panel testing detecting more than one type of vaginitis may be reimbursable.

Added specific NAAT testing language to #8 and #9.

References revised and updated across multiple updates (2023-2025).

2025-08-08plan effective date

12+reimbursable rules

Vaginitis Testing: Reimbursement Criteria

Vaginitis testing reimbursement criteria

Reimbursement determinations based on symptom status, test type, and risk factors:

ALL of the following

ANY of the following
- For individuals with signs and symptoms of vaginitis, testing of pH, testing for the presence of amines, measurement of sialidase activity, saline wet mount, potassium hydroxide/KOH wet mount, and microscopic examination of vaginal fluids may be reimbursable.
- For individuals with signs and symptoms of vaginitis, direct Probe DNA-based identification of Gardnerella, Trichomonas, and Candida (e.g., BD Affirm™ VPIII) may be reimbursable.
- For individuals with signs and symptoms of vaginitis, but with negative findings on wet-mount preparations and a normal pH test, vaginal cultures for Candida species for the diagnosis of vulvovaginal candidiasis may be reimbursable.
- For individuals with signs and symptoms of vaginitis, nucleic acid amplification test/NAAT or polymerase chain reaction/PCR-based identification of Trichomonas vaginalis may be reimbursable.
- For individuals with signs and symptoms of vaginitis, NAAT panel 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) may be reimbursable.
- For individuals with signs and symptoms of bacterial vaginosis/BV, NAAT specific to the diagnosis of BV (e.g., Aptima® BV, OneSwab® BV Panel PCR with Lactobacillus Profiling by qPCR; SureSwab® Advanced BV, TMA) and single or multitarget PCR testing for the diagnosis of BV may be reimbursable.
- For individuals with complicated vulvovaginal candidiasis/VVC, polymerase chain reaction/PCR-based identification of Candida to confirm clinical diagnosis and identify non-albicans Candida may be reimbursable.

ALL of the following

ANY of the following
- For individuals with risk factors for Trichomonas (new or multiple partners; history of sexually transmitted infections [STIs], especially HIV; exchange of sex for payment; incarceration; or injection drug use), screening for Trichomonas may be reimbursable.

ALL of the following

ANY of the following
- For asymptomatic individuals, including asymptomatic pregnant individuals at an average or high risk for premature labor, screening for trichomoniasis and bacterial vaginosis is not reimbursable.
- For individuals with symptoms of vaginitis, rapid identification of Trichomonas by enzyme immunoassay is not reimbursable.
- Testing for microorganisms involved in vaginal flora imbalance and/or infertility using molecular-based panel testing is not reimbursable.
- All other tests for vaginitis not addressed above are not reimbursable.

Reimbursement criteria updates

Reimbursement information and coverage stance changes over time:

ALL of the following

NAAT multi-target panel testing that detects more than one vaginitis etiology (VVC, BV, trichomoniasis) may be reimbursable.

ALL of the following

Measurement of sialidase activity was added to allowable test components in reimbursement item #1; this change resulted in deletion of the prior item #4.

ALL of the following

Terminology change: 'hydrogen peroxide' was replaced with 'potassium hydroxide' in reimbursement item #1 for clarity.

ALL of the following

Procedure Codes and Coding Notes

Listed procedure codesmixed

81513
81514
81515
82120
83986
87070
87149
87150
87210
87480

1–10 of 27

1/3

Updated/replaced laboratory test codesCPT

81515	Molecular pathology—specific code added per policy update
0505U	FDA EUA/unique molecular test code added per policy update
0352U	Previously listed code deleted per policy update

Code list completeness note

Code list scopeThe listed procedure codes are not all‑encompassing; inclusion of a code does not guarantee it is a covered service or eligible for reimbursement.

Example codes includedCodes listed in the policy include 81513, 81514, 81515, 0505U, Q0111 and others (see Coding section).

Billing responsibilityProviders must submit claims using valid code combinations from HIPAA‑approved code sets and code claims per industry standard coding guidelines.

Claim review caveatClaims are subject to code edit protocols and claim review against benefit coverage, provider contracts, medical and coding policies.

Provider actionUpon request, providers are urged to submit additional documentation to support billed services.

Documentation, Billing, and Provider Notices

Documentation Required

Documentation & Claim Review — Providers are responsible for submission of accurate documentation of services performed and are urged to submit additional documentation...

Providers are responsible for submission of accurate documentation of services performed and are urged to submit additional documentation upon request. Claims must be coded using HIPAA-approved code sets and in accordance with industry-standard coding guidelines (e.g., CPT®, HCPCS, ICD-10-CM/PCS, NDC). Claims are subject to code edit protocols and review for benefit coverage, provider contract terms, medical policies, clinical payment and coding policies, and coding software logic.

Submit claims with valid code combinations from HIPAA-approved code sets.
Be prepared to provide additional documentation upon request for claim review.

Billing Rule

Reimbursement and coding updates for vaginitis testing — Policy reimbursement information updated to add codes 81515 and 0505U and delete 0352U; NAAT multi-target panel testing (e.g., BD MAX Vag...

Definitions and Coverage Examples

Reimbursable tests described in the policy

Definition - Reimbursable testsReimbursable tests described in the policy are those the plan may reimburse when coverage criteria are met (for example, individuals with signs and symptoms of vaginitis).

ContextNot all requirements apply to each product; providers should review plan documents for eligible coverage.

Documentation expectationProviders are responsible for submission of accurate documentation of services performed and must code claims appropriately per industry standards.

Non‑reimbursable tests and screening (policy examples)

Not reimbursable — asymptomatic screeningScreening for trichomoniasis and bacterial vaginosis in asymptomatic individuals, including asymptomatic pregnant persons at average or high risk for premature labor, is not reimbursable.