CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO66

DNA Ploidy Cell Cycle Analysis

This document governs reimbursement criteria for laboratory measurement of flow cytometry-derived DNA content (DNA ploidy) and cell proliferative activity (S-phase fraction) for BCBSOK members and providers. It applies to Blue Cross Blue Shield - Oklahoma products; providers should also review specific plan documents for product-specific requirements.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDNA Ploidy Cell Cycle Analysis

Policy CodePolicy CPCPLABO66

Change TypeNo material changes

Effective DateNov 1, 2022

Next Review Date

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

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1policy creation / new policy entry

Nov. 1, 2022plan effective date

Not reimbursablestance on routine clinical use for cancer management

Multiplesupporting citations included

DNA Ploidy and S-Phase Fraction Reimbursement Criteria

DNA ploidy / S-phase fraction reimbursement criteria

Covered when ALL of the following apply:

Measurement of flow cytometry-derived DNA content (DNA Index) or cell proliferative activity (S-phase fraction or % S-phase) for prognostic or therapeutic purposes in the routine clinical management of cancers is not reimbursable.

Not all lab management reimbursement requirements apply to each product; providers should review specific plan documents for coverage determination.

If conflict exists between this Clinical Payment and Coding Policy (CPCP) and a plan document, the plan document governs; if conflict exists with a provider contract, the provider contract governs. BCBSOK retains discretionary authority in interpretation and application.

Coding and Code Set Requirements

Coding guidancemixed

No codes listed

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyDNA Ploidy Cell Cycle Analysis

Policy CodePolicy CPCPLABO66

Change TypeNo material changes

Effective DateNov 1, 2022

Next Review Date

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

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.

Required code setsClaims must be submitted using valid HIPAA-approved code sets (for example: CPT, HCPCS, ICD-10-CM/PCS, NDC).

Coding guidelines to followCode claims appropriately per industry-standard coding guidance (e.g., AMA CPT, CPT Assistant, UB editor, DRG guidelines).

Edit and policy checksClaims are subject to code edit protocols and claim review including CMS NCCI policy manual, CCI table edits, and coding software logic.

Provider responsibilityProviders are responsible for submitting accurate documentation and may be asked to submit additional documentation upon request.

Hierarchy for conflictsIf a conflict exists between this policy and a plan document, the plan document governs; if conflict with a provider contract, the provider contract governs.

Documentation, Claim Submission, and Review

Documentation Required

Documentation and claim review — provider responsibilities

Providers are responsible for submitting accurate documentation for services rendered and must code claims using valid HIPAA‑approved code sets; upon request, providers should submit any additional documentation to support the claim.

Submit claims using valid HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, NDC, etc.) and follow industry standard coding guidelines and edit protocols.
Respond to requests for additional documentation — claims are subject to review against plan documents, provider contracts, medical policies, and coding edits.

Definitions and Test Descriptions

Plan documents (examples)

Certificates of Health Care BenefitsIncluded as plan documents that govern coverage determinations.

Benefit bookletsListed as plan documents providers should review for coverage specifics.

Summary Plan DescriptionsConsidered plan documents that take precedence over this policy when conflicts arise.

Other coverage documentsAny additional plan-specific coverage documents that define member entitlements and may govern over this CPCP.

Definitions — DNA ploidy and S‑phase testing

DNA Index (DNA ploidy)Measurement of flow cytometry-derived DNA content (DNA Index).

S-phase fractionMeasurement of cell proliferative activity expressed as S-phase fraction or % S-phase.

Clinical purpose statedTests are referenced in the context of prognostic or therapeutic use in routine clinical management of cancers.