CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB035

Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Defines BCBSOK reimbursement policy for serologic and algorithm-based laboratory tests used in the diagnosis and monitoring of IBD; applies to providers submitting claims to Blue Cross Blue Shield of Oklahoma for covered members and is subject to plan documents and provider contracts.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyLaboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Policy CodePolicy CPCPLAB035

Change TypeLiterature/administrative updates

Effective DateFeb 1, 2024

Next Review Date

Key ActionDo not bill for the listed serologic markers or diagnostic algorithm–based panels (e.g., Prometheus®) for diagnosis or monitoring of IBD; submit accurate documentation if requested.

SourceLink

POLICY UPDATE CHANGES

02/01/2024 — Document updated with literature review; reimbursement information unchanged; references revised.

07/05/2023 — Document updated with literature review; reimbursement information revised for clarity.

11/01/2022 — New policy created.

11specific non-reimbursable serologic markers listed

1algorithm-based test approach explicitly non-reimbursable (eg, Prometheus®)

12procedure/test codes listed as examples

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 exclusions for laboratory testing in IBD workup and monitoring

The following tests/approaches are not reimbursable for diagnosis or monitoring of IBD:

ALL of the following

Use of listed serologic markers (individual tests) for workup and monitoring of IBD is not reimbursable.
Use of diagnostic algorithm–based testing that combines serologic, genetic, and inflammation markers (example: Prometheus® testing) for diagnosis or monitoring of IBD is not reimbursable.

Billing and documentation guidance

Billing Rule

Do not bill for excluded serologic and algorithm-based IBD tests

Providers should not expect reimbursement for the listed serologic markers or for diagnostic algorithm–based panels (e.g., Prometheus®) when used for diagnosis or monitoring of IBD. Inclusion of a code in the document does not guarantee coverage; claims remain subject to plan documents, provider contract language, and code edit protocols.

82397
83516
83520
86021
86036
86037
86255
86671
88346
88350
0164U
0176U
Note: Inclusion of a code in this list does not guarantee coverage; claims remain subject to plan documents, provider contract language, and code edit protocols.

Documentation Required

Submit accurate documentation upon request

Upon request BCBSOK may require additional documentation to review claims. Providers are responsible for submitting accurate documentation and using valid HIPAA-approved code combinations following standard coding guidelines.

BCBSOK may request additional documentation to review claims; providers must respond and submit supporting records as requested.
Submit claims using valid HIPAA‑approved code combinations and follow industry standard coding guidelines (CPT, HCPCS, ICD-10, UB, NCCI/CCI edits, etc.).

Scope and intent

This policy defines Blue Cross Blue Shield of Oklahoma's reimbursement position for serologic and algorithm-based laboratory tests used in the diagnosis and monitoring of inflammatory bowel disease (IBD). Per the policy, the use of listed serologic markers (for example, ANCA, ASCA, pANCA, anti-OmpC, anti-I2, anti-cBir1, ACCA IgA, ALCA IgG, AMCA IgG, PKM2) and diagnostic algorithm–based testing that combines serologic, genetic, and inflammation markers (e.g., Prometheus® testing) for the workup or monitoring of IBD is not reimbursable.

This policy applies to providers submitting claims to Blue Cross Blue Shield of Oklahoma for covered members. Providers should review applicable plan documents and provider contracts because coverage is subject to those documents; if a conflict exists, the plan document or provider contract governs. BCBSOK may request additional documentation to review claims, and providers are responsible for submitting accurate documentation and using valid HIPAA-approved code combinations following standard coding guidelines.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyLaboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Policy CodePolicy CPCPLAB035

Change TypeLiterature/administrative updates

Effective DateFeb 1, 2024

Next Review Date

Key ActionDo not bill for the listed serologic markers or diagnostic algorithm–based panels (e.g., Prometheus®) for diagnosis or monitoring of IBD; submit accurate documentation if requested.

SourceLink

On This Page

OpenPayer

Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Reimbursement exclusions for laboratory testing in IBD

Example procedure and test codes

Billing and documentation guidance

Scope and intent

Defined terms

Policy update changes

82397
83516
83520
86021
86036
86037
86255
86671
88346
88350

Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Reimbursement exclusions for laboratory testing in IBD

Example procedure and test codes

Billing and documentation guidance

Scope and intent

Defined terms

Policy update changes

Contract and product notes