CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB041

Erectile Dysfunction

Defines lab tests that may or may not be reimbursable by BCBS Oklahoma when used in the evaluation/diagnosis of erectile dysfunction; applies to providers submitting claims to BCBS OK and varies by product/plan documents.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyErectile Dysfunction

Policy CodePolicy CPCPLAB041

Change TypeNew policy

Effective DateNov 1, 2022

Next Review Date

Key ActionProviders must submit accurate documentation and bill using valid HIPAA-approved codes and, upon request, provide additional documentation to support claims.

SourceLink

POLICY UPDATE CHANGES

Policy created and effective Nov. 1, 2022 as a new policy.

9Listed types of lab tests that may be reimbursable

4Explicitly listed non-reimbursable tests

23Listed codes in policy

Reimbursable and Non-reimbursable Laboratory Tests

Reimbursable laboratory tests for erectile dysfunction

The following laboratory tests may be reimbursable in the diagnosis of erectile dysfunction (coverage subject to plan documents and product-specific requirements).

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyErectile Dysfunction

Policy CodePolicy CPCPLAB041

Change TypeNew policy

Effective DateNov 1, 2022

Next Review Date

Key ActionProviders must submit accurate documentation and bill using valid HIPAA-approved codes and, upon request, provide additional documentation to support claims.

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.

ALL of the following

Blood glucose (Fasting/HbA1c)
Complete blood count
Creatinine and Blood Urea Nitrogen (BUN)
Hepatic panel
Lipid profile
Prostate specific antigen (PSA)
Serum testosterone (Total/Free or Bioavailable) — see CPCPLAB09 Testosterone Testing
Thyroid function studies
Urinalysis

ALL of the following

Blood glucose (Fasting/HbA1c)
Complete blood count
Creatinine and Blood Urea Nitrogen (BUN)
Hepatic panel
Lipid profile
Prostate specific antigen (PSA)
Serum testosterone (Total/Free or Bioavailable) — see CPCPLAB09 Testosterone Testing

Not reimbursable laboratory tests for erectile dysfunction

The following tests are explicitly listed as not reimbursable for the diagnosis of erectile dysfunction.

ANY of the following

Angiotensin-converting enzyme insertion/deletion polymorphism testing
Endothelial nitric oxide synthase polymorphism testing (4 VNTR, G894T, and T786C)
Iron binding capacity
Prostatic acid phosphatase

ANY of the following

Angiotensin-converting enzyme insertion/deletion polymorphism testing
Endothelial nitric oxide synthase polymorphism testing (4 VNTR, G894T, and T786C)
Iron binding capacity
Prostatic acid phosphatase

Relevant Procedure and Assay Codes

Listed CPT/HCPCS/assay codes related to erectile dysfunction lab testingmixed

80061	Lipid panel
80076	Hepatic function panel
81002	Urinalysis, non-automated without microscopy
81003	Urinalysis, automated, without microscopy
81005	Urinalysis; urine sediment, microscopic only
81400	Molecular pathology procedure, Level 1 (unlisted aspects)
81479	Unlisted molecular pathology procedure
82565	Creatine kinase (CK) assay (note: code listed in policy)
82570	Creatinine; measurement (note: code listed in policy)
82947	Glucose; quantitative, blood

1–10 of 23

1/3

Billing, Documentation, and Plan-specific Requirements

Documentation Required

Accurate documentation and coding

Providers are responsible for submission of accurate documentation of services performed and are expected to submit claims using valid HIPAA-approved code sets, coded appropriately according to industry coding guidelines. Upon request, providers should submit any additional documentation.

Billing Rule

Claims subject to code edit protocols and review

Claims are subject to code edit protocols and review including plan benefit terms, provider contract language, medical policies, clinical payment and coding policies, and coding software logic.

Prior Authorization

Plan/product-specific coverage

Not all requirements apply to each product; providers must review member plan documents to determine eligible coverage and any product-specific requirements prior to billing.

Scope and Purpose

This policy, CPCPLAB041, defines which laboratory tests may be reimbursable and which tests are not reimbursable when used in the evaluation and diagnosis of erectile dysfunction. It applies to providers submitting claims to Blue Cross Blue Shield of Oklahoma and is subject to product- and plan-specific coverage criteria; providers should review applicable plan documents for member eligibility and benefit terms.

The policy lists specific categories of tests that may be covered — including blood glucose (fasting/HbA1c), complete blood count, renal function (creatinine/BUN), hepatic panel, lipid profile, prostate specific antigen (PSA), serum testosterone (total/free or bioavailable), thyroid function studies, and urinalysis — and also identifies certain tests that are not reimbursable for erectile dysfunction, such as angiotensin-converting enzyme insertion/deletion polymorphism testing, endothelial nitric oxide synthase polymorphism testing, iron binding capacity, and prostatic acid phosphatase.

Providers are responsible for submitting accurate documentation and using valid HIPAA-approved codes on claims. Claims are subject to code edits and review against plan benefit terms, provider contracts, clinical payment and coding policies, and coding software logic; if a conflict exists between this policy and a member's plan document or provider contract, the plan document or contract governs and BCBS OK may use reasonable discretion in the policy's interpretation and application.

OpenPayer

Erectile Dysfunction

Reimbursable and Non-reimbursable Laboratory Tests

Relevant Procedure and Assay Codes

Billing, Documentation, and Plan-specific Requirements

Scope and Purpose

Defined Terms

Policy Update Changes

Erectile Dysfunction

Reimbursable and Non-reimbursable Laboratory Tests

Relevant Procedure and Assay Codes

Billing, Documentation, and Plan-specific Requirements

Scope and Purpose

Defined Terms

Policy Update Changes

Cross-reference