CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB024

Epithelial Cell Cytology in Breast Cancer Risk Assessment

This policy governs BCBSOK reimbursement for cytologic analysis of epithelial cells from nipple aspiration/ductal lavage used to assess breast cancer risk, and applies to providers submitting claims to Blue Cross Blue Shield - Oklahoma.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyEpithelial Cell Cytology in Breast Cancer Risk Assessment

Policy CodePolicy CPCPLAB024

Change TypeNon‑material revision

Effective DateNov 1, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to benefit, contract, medical policy, and coding review.

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review; reimbursement information unchanged.

New policy created on 11/1/2022.

2023-11-01plan effective

Not reimbursablereimbursement stance

88108, 88112example codes

2023-07-05committee approval

Coverage Criteria — Nipple Aspiration Cytology

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Nipple aspiration cytology coverage

Reimbursement and applicability:

ALL of the following

Cytologic analysis of epithelial cells from nipple aspirations (including ductal lavage and suction) to assess breast cancer risk is not reimbursable.
Techniques of collecting nipple aspiration fluid include, but are not limited to, ductal lavage and suction.
Not all lab management reimbursement criteria apply to every product; providers should review member plan documents for eligible coverage.
Procedure codes may be listed for reference in this policy, but inclusion does not guarantee coverage or reimbursement. Providers should refer to plan documents and coding guidelines when submitting claims.

This policy applies to providers submitting claims to Blue Cross Blue Shield - Oklahoma; claims are subject to benefit, contract, medical policy, and coding review as applicable.

Coding and Reimbursement Details

Procedure Codes mentionedCPTNot Covered

88108	88108
88112	88112

Reimbursement eligibility — Nipple aspiration cytology

Reimbursement eligibilityCytologic analysis of epithelial cells from nipple aspirations (including ductal lavage and suction) to assess breast cancer risk is not reimbursable.

Applicable proceduresIncludes cytologic analysis of specimens obtained via nipple aspiration and ductal lavage.

Policy scopeThis reimbursement stance applies to claims submitted to Blue Cross Blue Shield - Oklahoma under policy CPCPLAB024.

Provider Documentation and Billing Actions

Documentation Required

Documentation and claims review

Providers are responsible for submission of accurate documentation of services performed. Claims are subject to claim review including, but not limited to, any terms of benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. Upon request, the provider is urged to submit any additional documentation.

Submit accurate documentation of services performed with each claim.
Be prepared to provide additional documentation upon BCBSOK request for claim review.
Claims may be reviewed against member plan documents, provider contracts, medical policy, and coding protocols.

Billing Rule

Coding requirements

Claims should be submitted using valid code combinations from HIPAA‑approved code sets and coded appropriately according to industry standard coding guidelines.

Use HIPAA‑approved code sets (e.g., CPT, HCPCS, ICD‑10) and valid code combinations.
Follow industry coding guidelines including UB Editor, AMA CPT/CPT Assistant, CMS NCCI policy manual and CCI table edits.
Ensure coding aligns with applicable plan documents and provider contract language.

Definitions and Techniques

Nipple aspiration techniques

Collection techniquesDuctal lavage and suction are listed techniques for collecting nipple aspiration fluid.

Related proceduresCytologic analysis performed on fluid collected by these techniques is considered in the policy's not-reimbursable stance.

Documentation guidanceProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

Plan documents

Certificates of Health Care BenefitsIncluded as plan documents that govern coverage in case of conflict with CPCP.

Benefit bookletsIncluded as plan documents that govern coverage in case of conflict with CPCP.

Summary Plan Descriptions (SPDs)Included as plan documents that govern coverage in case of conflict with CPCP.

Other coverage documentsOther plan documents may include additional coverage terms; plan documents govern over CPCP when conflicts arise.