CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO15

Hepatitis Testing

Defines BCBSOK laboratory reimbursement criteria for hepatitis B and C testing (screening, follow-up, and related viral load/genotype testing) and applies to providers submitting claims to Blue Cross Blue Shield of Oklahoma.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyHepatitis Testing

Policy CodePolicy CPCPLABO15

Change TypeUpdated reimbursement statements and clarifications

Effective DateNov 1, 2023

Next Review Date

Key ActionSubmit accurate documentation and use valid HIPAA-approved code combinations; claims are subject to review and plan contract/benefit terms.

SourceLink

POLICY UPDATE CHANGES

Reimbursement information revised to add new statements #1, 2, 3, 4, 8; specified antibody screening as the allowed test for initial HCV screening in #5, 6, 7; added 'forty-eight weeks' in #10d; added Note 1.

≥1 annualasymptomatic, non-pregnant individuals with specified high-risk indications

onceHCV antibody testing once per lifetime

13procedure codes listed (not exhaustive)

8/15/2023document update history

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.

Reimbursement criteria for Hepatitis B and C testing

Reimbursable testing when meeting specific indications

ALL of the following

ANY of the following
- Individuals born in geographic regions with a HBsAg prevalence \u2265 2% (See Note 1)
- U.S.-born individuals not vaccinated as infants whose parents were born in geographic regions with a HBsAg prevalence \u2265 8% (See Note 1)
HBsAg and hepatitis B surface antibody (anti-HBs) for infants born to an HBsAg-positive individual
ALL of the following
- Injection-drug users
- Men who have sex with men
- Individuals with select medical conditions who require cytotoxic or immunosuppressive therapy
- Household contacts, needle-sharing contacts, and sex partners of HBV-infected individuals
- Individuals on long-term hemodialysis
- Individuals infected with HIV
- Healthcare and public safety workers exposed to blood or body fluids

ALL of the following

For individuals who test positive for HBV by initial antibody screening, follow-up serologic testing (anti-HBc, anti-HBs, IgM anti-HBc) may be reimbursable
For individuals who test positive and will undergo immunosuppressive drug therapy, HBV DNA testing may be reimbursable
Anti-HBs testing may be reimbursable for confirmation of seroconversion after hepatitis B vaccination

ALL of the following

CDC-defined geographic prevalence reference provided for determining high-risk regions for HBV (See Note 1): https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hepatitis-b

Procedure Codes and Testing Frequency

Listed procedure codes (not exhaustive)mixed

86704	Hepatitis B surface antibody
86705	Hepatitis B surface antigen
86706	Hepatitis B core antibody
86803	Hepatitis C antibody
86804	Hepatitis C confirmatory or related
87340	Hepatitis B test (molecular/other)
87341	Hepatitis B viral test
87517	Hepatitis C virus RNA detection/qualitative
87520	HCV RNA quantitative
87521	HCV RNA quant/viral load

1–10 of 14

1/2

HCV antibody testing frequency

FrequencyOne-time (once per lifetime) antibody testing for Hepatitis C (HCV) for all individuals ≥18 years of age; routine periodic antibody testing allowed for individuals with ongoing risk factors while risk persists.

One-time post-exposure/conditional testingOne-time, post-exposure or conditional HCV antibody testing is reimbursable for recognized exposures/conditions (e.g., illicit intranasal/injectable drug use; clotting factor before 1987; hemodialysis history; organ transplant or transfusion before July 1992; tattoos in unregulated settings; children born to HCV-positive individuals; history of incarceration; healthcare workers after exposure; current sexual partners of HCV-infected persons).

Routine periodic testing contextsRoutine periodic antibody testing reimbursable while risk persists for ongoing injection drug use with sharing, ongoing hemodialysis, or high-risk sexual behavior.

Test Definitions and Intended Uses

Hepatitis B surface antigen (HBsAg)

Primary useHepatitis B surface antigen (HBsAg) is used for screening and diagnosis in specified high-risk situations (e.g., individuals born in regions with HBsAg prevalence ≥2%, U.S.-born unvaccinated individuals with parents from regions ≥8%).

Infant testingHBsAg testing is reimbursable for infants born to an HBsAg-positive individual.

High-risk groupsHBsAg (with anti-HBs and total anti-HBc) is reimbursable for high-risk groups including injection-drug users, men who have sex with men, candidates for immunosuppressive therapy, household/needle-sharing/sex partners of HBV-infected individuals, long-term hemodialysis patients, HIV-infected individuals, and healthcare/public safety workers after exposure.

Hepatitis B surface antibody (anti-HBs)

Primary useHepatitis B surface antibody (anti-HBs) is used to confirm seroconversion after hepatitis B vaccination.

Infant useAnti-HBs testing is reimbursable for infants born to an HBsAg-positive individual (often performed with HBsAg).

Follow-up serologyAnti-HBs may be part of follow-up serologic testing (with anti-HBc, IgM anti-HBc) for individuals who test positive by initial antibody screening.

HCV antibody screening (initial test)

Allowed initial methodInitial antibody screening test for hepatitis C (HCV antibody testing) is specified as the allowed initial HCV screening method; follow-up nucleic acid testing (HCV RNA) is used to differentiate active vs resolved infection.

Subsequent testing guidanceFor individuals who test positive by initial HCV antibody screening, follow-up HCV RNA nucleic acid testing may be reimbursable to assess active infection and guide treatment.

Use before treatmentPrior to initiation of direct-acting antiviral (DAA) therapy, one-time HCV genotype testing and quantitative HCV viral load testing are reimbursable as indicated to guide therapy and monitor response.

Documentation and Claims Submission Requirements

Documentation Required

Submit accurate documentation and HIPAA‑approved codes; expect claim review

Providers must submit accurate documentation of services performed and submit claims using valid HIPAA‑approved code sets and industry-standard coding guidelines. Claims are subject to code edit protocols and claim review, and plan documents or provider contracts govern in case of conflict; BCBSOK may request additional documentation to support the claim.

Submit claims using valid HIPAA-approved code combinations and industry coding guidelines (CPT, HCPCS, ICD-10, NDC, DRG, CMS NCCI/CCI edits).
Claims are subject to code edit protocols, claim review, and the terms of the member’s plan document or provider contract which govern in conflicts.
Be prepared to provide additional documentation upon request to support medical necessity and coding.

Policy Update History

2023-08-15policy_created_or_updatedLatest

New policy created and updated with literature review; reimbursement information revised to add statements #1, #2, #3, #4, and #8; specified antibody screening as the allowed test for initial HCV screening in items #5, #6, and #7; added 'forty-eight weeks' in follow-up timing and added Note 1; title and references updated.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyHepatitis Testing

Policy CodePolicy CPCPLABO15

Change TypeUpdated reimbursement statements and clarifications

Effective DateNov 1, 2023

Next Review Date

Key ActionSubmit accurate documentation and use valid HIPAA-approved code combinations; claims are subject to review and plan contract/benefit terms.

SourceLink

On This Page

OpenPayer

Hepatitis Testing

Reimbursement Criteria for Hepatitis B and C Testing

Procedure Codes and Testing Frequency

Test Definitions and Intended Uses

Documentation and Claims Submission Requirements

Policy Update History