CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO03O

In Vitro Chemoresistance and Chemosensitivity Assays

This policy defines Blue Cross Blue Shield - Oklahoma's reimbursement stance for in vitro chemosensitivity and chemoresistance assays and lists related procedure codes; it applies to providers submitting claims to BCBSOK for these assays.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyIn Vitro Chemoresistance and Chemosensitivity Assays

Policy CodePolicy CPCPLABO03O

Change TypeCode list updates (addition and deletion)

Effective DateSep 26, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and use valid HIPAA code sets; claims are subject to review and plan documents govern in case of conflict.

SourceLink

POLICY UPDATE CHANGES

Added code 0525U.

Deleted code 0564T.

Document updated with literature review; reimbursement information unchanged.

5Listed procedure codes

not reimbursableChemosensitivity stance

not reimbursableChemoresistance stance

multipleLiterature references

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Non-reimbursable assays

Covered when ALL of the following are met:

ALL of the following

ONE OF
- In vitro chemosensitivity assays (e.g., histoculture drug response assay, fluorescent cytoprint assay) are not reimbursable.
- In vitro chemoresistance assays (e.g., extreme drug resistance [EDR] assays) are not reimbursable.

Procedure Codes

Listed relevant CPT/HCPCS U-codesCPTNot Covered

0248U
0249U
0285U
0435U
0525U

Code inclusion notice

NoticeThe inclusion of a procedure code in this policy does not guarantee that the code is a covered service or eligible for reimbursement.

Code list scopeThe procedure code list is not all-encompassing; other relevant codes may exist outside this list.

Payment determinationCoverage and reimbursement determinations are subject to contract terms, plan documents, and applicable benefit design.

Claims Submission and Documentation

Documentation Required

Claims submission, coding and documentation requirements

Providers must submit accurate documentation of services performed and code claims using valid HIPAA-approved code sets and industry-standard coding guidelines. Claims are subject to code edit protocols and may be reviewed against benefit coverage, provider contracts, medical policies, clinical payment and coding policies, and coding software logic; providers may be asked to submit additional documentation upon request. If a conflict exists between this policy and a member’s plan document or provider contract, the plan document or provider contract governs, respectively.

Submit claims using valid code combinations from HIPAA-approved code sets (e.g., CPT, HCPCS, ICD-10-CM/PCS, NDC).
Code claims according to industry standard coding guidelines (e.g., AMA CPT, CMS NCCI, UB Editor, DRG guidelines).
Be prepared to provide additional documentation upon request for claim review.
Note that plan documents or provider contracts govern in case of conflict with this policy.

Definitions and Plan Criteria

Plan's lab management reimbursement criteria

Plan lab management criteriaThe Plan has implemented certain lab management reimbursement criteria; not all requirements apply to each product.

Provider responsibilityProviders are urged to review specific Plan documents to determine eligible coverage for services rendered.

ApplicabilityCriteria may vary by product and benefit; check member-specific plan documents for applicability.

DocumentationProviders should submit appropriate documentation as required by the Plan to support claims and reimbursement requests.