CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB030

In Vitro Chemoresistance and Chemosensitivity Assays

Defines BCBS Oklahoma reimbursement stance for in vitro chemosensitivity and chemoresistance laboratory assays and the expectations for provider coding and documentation; applies to services billed to BCBSOK plans unless a conflicting plan document or provider contract governs.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyIn Vitro Chemoresistance and Chemosensitivity Assays

Policy CodePolicy CPCPLAB030

Change TypeReimbursement language revised

Effective DateFeb. 1, 2024

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request; claims are subject to claim review and code edit protocols.

SourceLink

POLICY UPDATE CHANGES

Reimbursement Information revised for clarity.

Document updated with literature review.

New policy created on 11/01/2022.

2assay categories not reimbursed

CPCPLAB030policy id

2024-02-01plan effective

Reimbursement Determinations

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Documentation, Coding and Claim Review

Documentation Required

Documentation and claim review

Providers are responsible for submission of accurate documentation of services performed. Claims are subject to claim review, and upon request providers must submit any additional documentation to support the claim.

Submit accurate documentation of services performed.
Provide additional documentation upon request to support claim review.

Billing Rule

Coding requirements

Claims must be submitted using valid HIPAA‑approved code sets and coded according to industry standard coding guidelines; claims are also subject to code edit protocols.

Use HIPAA‑approved code sets (e.g., CPT, HCPCS, ICD-10, NDC, UB, DRG).
Follow industry coding guidance including AMA CPT, CMS NCCI policy manual and CCI table edits.
Claims are subject to code edit protocols and should use valid code combinations.

Assay Definitions

Assays — In vitro chemosensitivity and chemoresistance assays

DefinitionIn vitro chemosensitivity assays and in vitro chemoresistance assays

Examples of in vitro chemosensitivity assaysHistoculture drug response assay; fluorescent cytoprint assay

Example of in vitro chemoresistance assayExtreme drug resistance (EDR) assays

Reimbursement stanceThese assay categories are not reimbursable by BCBSOK

Plan applicability noteNot all requirements apply to each product — plan documents and provider contracts govern in case of conflict