CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB030

In Vitro Chemoresistance and Chemosensitivity Assays

This policy governs reimbursement coverage for in vitro chemoresistance and chemosensitivity laboratory assays for Blue Cross Blue Shield of Oklahoma members; it applies to providers submitting claims to BCBSOK and directs review against plan documents and provider contracts.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyIn Vitro Chemoresistance and Chemosensitivity Assays

Policy CodePolicy CPCPLAB030

Change TypeCode updates and literature clarifications

Effective Date01/03/2026

Next Review Date

Key ActionSubmit accurate documentation with claims and be prepared to provide additional records upon request.

SourceLink

POLICY UPDATE CHANGES

Added code 0525U.

Deleted code 0564T.

Document updated with literature review; reimbursement information unchanged.

2assay types not reimbursable

15+procedure & U-codes listed

CPCPLAB030policy id

09/26/2025last review

Reimbursement and Coverage Determination

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Reimbursement Information — In Vitro Chemosensitivity and Chemoresistance Assays

Reimbursement determination for assays

ALL of the following

NOT REIMBURSABLE - Chemosensitivity: In vitro chemosensitivity assays (e.g., histoculture drug response assay, fluorescent cytoprint assay) are not reimbursable.
NOT REIMBURSABLE - Chemoresistance: In vitro chemoresistance assays (e.g., extreme drug resistance [EDR] assays) are not reimbursable.

Procedure and Code References

Listed procedure and U-codes referenced in policymixed

81535
81536
86849
88104
88199
88305
88313
88358
89050
89240

1–10 of 16

1/2

Code list completeness notice

Scope of code listThe procedure code list provided is not all‑encompassing; inclusion of a code does not guarantee it is a covered service or eligible for reimbursement.

Coverage not implied by listingA listed code may still be excluded from reimbursement depending on plan documents, medical policies, provider contracts, or claim review.

Provider responsibilityProviders should verify coverage and reimbursement eligibility for specific codes through applicable plan documents before billing.

Claim review appliesClaims for listed codes remain subject to standard claim review and code edit protocols which can affect payment determination.

Documentation, Claims and Coding Requirements

Documentation Required

Documentation and Claim Review

Providers are responsible for submission of accurate documentation of services performed and may be asked to provide additional documentation upon request; claim submissions are subject to claim review including benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic.

Submit accurate documentation of services performed.
Be prepared to provide additional documentation upon request for claim review.

Billing Rule

Coding Requirements

Claims must be submitted using valid HIPAA-approved code sets and coded according to industry standard coding guidelines; claims are also subject to code edit protocols.

Use valid code combinations from HIPAA-approved code sets (e.g., CPT, HCPCS, ICD-10-CM/PCS, NDC).
Code appropriately per industry guidance (Uniform Billing, AMA CPT Assistant, CMS NCCI, CCI edits, etc.).
Expect claims to be processed against code edit protocols.

Plan Documents and Scope

Plan documents (definitions)

What 'Plan documents' includeCertificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

Governing authorityIf a conflict arises between this policy and a member's plan document, the plan document will govern.

Provider contract precedenceIf a conflict arises between this policy and any provider contract, the provider contract will govern.

Provider actionProviders are urged to review plan documents to determine eligible coverage for services rendered as not all requirements apply to each product.