CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO43

Evaluation of Dry Eye (diagnostic testing reimbursement)

Governs reimbursement criteria for laboratory/point-of-care testing used in evaluation of patients suspected of having dry eye disease for Blue Cross Blue Shield of Oklahoma members and providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyEvaluation of Dry Eye (diagnostic testing reimbursement)

Policy CodePolicy CPCPLABO43

Change TypeNew policy

Effective DateNov 1, 2022

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

New policy created.

1.0policy version

2022-11-01plan effective date

4reimbursement items

Reimbursement Criteria

Reimbursement criteria

Reimbursement positions for specific tear/ocular surface tests:

ALL of the following

Tear osmolarity
- Testing of tear osmolarity in patients suspected of having dry eye may be reimbursable to aid in determining the severity of eye disease as well as monitor effectiveness of therapy
MMP-9 point-of-care immunoassay
- Testing for MMP-9 protein in human tears is not reimbursable to aid in the diagnosis of patients suspected of having dry eye disease based on comprehensive eye examination
Lactoferrin and/or IgE testing

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyEvaluation of Dry Eye (diagnostic testing reimbursement)

Policy CodePolicy CPCPLABO43

Change TypeNew policy

Effective DateNov 1, 2022

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

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.

Coding and Edit Protocols

Coding guidancemixed

Claims should be coded using HIPAA-approved code sets (CPT, HCPCS, ICD-10, NDC, DRG) and follow standard coding guidelines and CMS/NCCI edits.

Code edit protocol applicability

Scope of code-edit applicabilityClaims are subject to code edit protocols and claim review, including UB editor, AMA CPT guidance, CMS NCCI/CCI edits and other CMS guidelines.

Coding standards requiredProviders must submit claims using HIPAA‑approved code sets and follow industry standard coding guidelines (CPT, HCPCS, ICD‑10, NDC, DRG).

Claim review driversClaim submissions are subject to review against benefit coverage terms, provider contract language, medical policies, CPCPs, and coding software logic.

Documentation on requestUpon request, providers are urged to submit any additional documentation to support claims.

Authority for interpretationBCBSOK may use reasonable discretion and has final discretionary authority to interpret and apply this policy as provided under applicable plan documents.

Documentation and Claims Review Requirements

Documentation Required

Documentation, coding and claim review requirements

Providers are responsible for submitting accurate documentation of services performed and must code claims using valid HIPAA‑approved code sets and industry standard coding guidelines. Upon request, providers may be asked to submit additional documentation for claim review; claims are subject to plan documents, provider contracts, medical policies and code‑edit protocols.

Submit accurate documentation of services performed.
Use valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, NDC, DRG) and follow industry coding guidance (UB editor, AMA CPT, CMS NCCI/CCI edits).
Be prepared to provide additional documentation upon request for claim review.
Claims are subject to plan documents, provider contracts, medical policies and coding edit protocols.

Definitions and Governing Documents

Lab management reimbursement criteria — description

PurposeBCBSOK has implemented lab management reimbursement criteria to guide reimbursement for tests used in evaluation of dry eye.

ApplicabilityNot all requirements apply to each product; providers should review Plan documents for eligible coverage for services rendered.

Provider responsibilityProviders are urged to review plan documents to determine eligible coverage and applicability of these criteria.

ContextCriteria govern reimbursement for laboratory and point‑of‑care testing used in evaluation of patients suspected of having dry eye.

Plan documents / governing order

Governing order — plan documentsIf a conflict exists between this policy (CPCP) and any plan document under which a member is entitled to Covered Services, the plan document will govern.

Governing order — provider contractsIf a conflict exists between this policy and any provider contract pursuant to which a provider participates in providing Covered Services, the provider contract will govern.

Examples of plan documentsPlan documents include, but are not limited to: Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

BCBSOK discretionBCBSOK may use reasonable discretion in interpreting and applying this policy to services delivered in a particular case.