CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP028

Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)

Defines services and procedure codes that Blue Cross Blue Shield of Oklahoma will not reimburse because they are considered experimental, investigational, or unproven; applies to claims submitted to BCBSOK and affects participating providers and covered members.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyNon-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)

Policy CodePolicy CPCP028

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review Date

Key ActionClaims for services listed as experimental, investigational or unproven (including specified CPT Category III and other CPT/HCPCS codes) will be denied as non-reimbursable when submitted on a claim; providers should submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Maintained separatelyCode list status

IncludedCPT Category III

1.0Version

10/01/2025Committee approval

Non-Reimbursable Criteria

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Non-Reimbursable EIU Criteria

Services and procedure codes listed on the Non-Reimbursable EIU Services Code List are not reimbursable.

All CPT Category I, CPT Category III, and HCPCS codes identified on the Non-Reimbursable EIU Services Code List are denied as non-reimbursable when submitted on a claim; the list may not be all inclusive and is maintained separately from the policy.

Codes and Clinical Review

Non-Reimbursable EIU CodesmixedNot Covered

See 'Non-Reimbursable EIU Services Code List' attachment for CPT Category I, CPT Category III, and HCPCS codes denied as non-reimbursable.

Clinical review requirement

Clinical review requirementNone required for codes identified in the Non-Reimbursable EIU Services Code List; they are denied without clinical review.

Scope of denialIncludes CPT Category I, CPT Category III, and HCPCS codes listed on the Non-Reimbursable EIU Services Code List.

Reference for code listRefer to the 'Non-Reimbursable EIU Services Code List' posted with the policy for the specific codes denied.

Claims Handling and Documentation

Denial Risk

Claims for EIU-listed services denied; documentation must be accurate

Claims for services listed on the Non-Reimbursable EIU Services Code List (including CPT Category III and other CPT/HCPCS codes) will be denied as non-reimbursable when submitted on a claim; providers must submit accurate documentation and may be asked to provide additional documentation upon request.

Providers are responsible for submission of accurate documentation of services performed and should use valid, industry-standard code sets and coding guidelines.
Upon request, the provider is urged to submit any additional documentation to support the claim.

Key Definitions

CPT Category III (temporary CPT codes)

DefinitionTemporary CPT Category III codes are intended for data collection for emerging technologies, services, procedures, and service paradigms.

Policy treatmentCPT Category III codes are treated as experimental, investigational, or unproven (EIU) and are denied when listed on the Non-Reimbursable EIU Services Code List.

Claim handlingWhen CPT Category III codes are identified on the Non-Reimbursable EIU Services Code List they will be denied as non-reimbursable when submitted on a claim.