CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO44

Lyme Disease Testing

This Clinical Payment and Coding Policy describes BCBSOK reimbursement criteria for laboratory testing related to Lyme disease, including serologic and PCR-based testing, and who/when such testing may be reimbursable for members.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyLyme Disease Testing

Policy CodePolicy CPCPLABO44

Change TypeClarification and references updated (non-material)

Effective DateJan 15, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request; claims are subject to plan, contract, and coding policy review.

SourceLink

POLICY UPDATE CHANGES

Reimbursement information revised for clarity in the 11/01/2023 update.

Document with literature review added on 04/29/2024 with references updated.

Version 1.0policy version

2025-01-15plan effective date

7 codesexample codes included

04/29/2024last review

Lyme Testing Coverage Criteria

Lyme testing coverage criteria

Reimbursement criteria for laboratory testing for Lyme disease

Two-tier serologic testing (sensitive EIA or IFA followed by Western immunoblot or FDA-cleared second EIA) may be reimbursable for individuals with symptoms of Lyme disease and history of travel to an endemic region (with or without a history of a tick bite).

ONE OF the following clinical presentations

Acute myocarditis or pericarditis of unknown cause
Painful radiculoneuritis
Meningitis, encephalitis, or myelitis

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyLyme Disease Testing

Policy CodePolicy CPCPLABO44

Change TypeClarification and references updated (non-material)

Effective DateJan 15, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request; claims are subject to plan, contract, and coding policy review.

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.

Procedure Codes and Coding Rules

Example procedure codesCPT

86617	Borrelia burgdorferi antibody; not further specified (example included in list)
86618	Borrelia burgdorferi antibody; confirmatory (example included in list)
87475	Infectious agent detection by nucleic acid; Borrelia burgdorferi
87476	Infectious agent detection by nucleic acid; Borrelia species/other
0041U	Proprietary Lyme disease testing code (example included in list)
0042U	Proprietary Lyme disease testing code (example included in list)
0316U	Proprietary Lyme disease testing code (example included in list)

inv-03: Repeat serologic testing — Not reimbursable for individuals who have previously tested positive for Lyme disease

Policy statementRepeat serologic testing after a prior positive test for Lyme disease is not reimbursable.

ScopeApplies to individuals who have previously tested positive for Lyme disease.

Related exclusionsAll other testing for Borrelia burgdorferi not described in the policy is not reimbursable.

Exception notePCR-based direct detection in CSF may be reimbursable in specific short-duration neurologic presentations (<14 days) and is addressed separately in the policy.

Documentation and Claims Review

Documentation Required

Documentation and claims review

Providers are responsible for submitting accurate documentation of services performed and coding claims using valid HIPAA-approved code sets and industry standard coding guidelines. Claims are subject to claim and code-edit review and may be reviewed against benefit coverage, provider contract language, medical policies, and coding software logic; upon request, providers must submit additional documentation.

Submit claims using valid HIPAA-approved code sets and code combinations.
Code claims per industry standards (eg, CPT, HCPCS, ICD-10-CM/PCS, CMS NCCI guidance).
Be prepared to provide additional documentation upon request for plan, contract or coding policy review.

Plan Documents

inv-05: Plan documents include Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents used by BCBSOK.

DefinitionPlan documents include Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents Blue Cross and Blue Shield of Oklahoma may use.

Governing authorityIf a conflict exists between a Clinical Payment and Coding Policy and a plan document, the plan document governs.

Provider responsibilityProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to plan, contract, and coding policy review.

Interpretation discretionBCBSOK may use reasonable discretion interpreting and applying this policy and has final discretionary authority as provided under applicable plan documents.