CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO32

Oral Screening, Lesion Identification Systems and Genetic Screening

Governs BCBSOK lab management reimbursement criteria for oral screening, lesion identification systems, and genetic/HPV testing for oral/oropharyngeal cancers; applies to providers submitting claims to Blue Cross Blue Shield of Oklahoma.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyOral Screening, Lesion Identification Systems and Genetic Screening

Policy CodePolicy CPCPLABO32

Change TypeNew policy

Effective DateNov. 1, 2022

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review and code edit protocols.

SourceLink

POLICY UPDATE CHANGES

New policy

1.0policy version

Nov. 1, 2022Plan effective date

7procedure codes referenced

Multiplenon-reimbursable items

Coverage and Exclusions

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.

Coverage and exclusions for oral screening and genetic testing

Reimbursement guidance and explicit exclusions

ALL of the following

HPV testing methods
- ALL of the following
  - HPV E6/E7 mRNA expression testing
  - Expression of p16 detected by immunohistochemistry

ALL of the following

Named non‑reimbursable tests
- OraRiske HPV Complete Genotyping Test and OraRiske HPV 16/18/HR Test (OralDNA labs, Brentwood, TN)
- MOPTM testing
- SaliMark OSCCC (PeriRx)
ALL of the following
- Salivary biomarkers examples
  - Salivary peptides and proteins (e.g., protein 14, Mac‑2 binding protein, profilin 1)
  - Salivary nucleic acids (e.g., methylated DNA testing, mRNAs, modified nucleotides such as 8‑OHdG, microRNA/miRNAs)
  - Salivary metabolites (e.g., valine, lactic acid, phenylalanine)

Procedure Codes and Claim Coding Standards

Procedure codes referencedCPT

81599
82397
87623
87624
87625
88341
88342

Procedure codes referenced (alternate format)CPT

81599
82397
87623
87624
87625
88341
88342

Claim coding standards

Required code setsClaims must be submitted using HIPAA‑approved code sets (e.g., AMA CPT, HCPCS)

Industry coding guidelinesCode claims according to industry standard coding guidelines including UB Editor, AMA CPT, CPT Assistant, HCPCS, ICD-10‑CM/PCS, NDC, DRG, CMS NCCI/CCI and related CMS manuals

Valid code combinationsProviders must submit claims using valid code combinations from HIPAA approved code sets

Code edit protocolsClaims are subject to code edit protocols and claim review, including coding software logic and CCI table edits

Documentation requirementProviders are responsible for submission of accurate documentation and may be asked to provide additional documentation upon request

Documentation and Claim Review Requirements

Documentation Required

Documentation, claim review, and submission requirements

Providers are responsible for submission of accurate documentation of services performed and must submit claims using valid HIPAA‑approved code sets and industry-standard coding guidelines. Upon request, providers are urged to submit any additional documentation for claim review; claims are subject to code edit protocols, benefit/contract terms, medical policies, CPCPs and coding software logic and may be adjudicated per plan documents and provider contracts.

Submit claims using valid code combinations from HIPAA‑approved code sets (e.g., UB, AMA CPT, HCPCS, ICD-10, NDC, DRG).
Be prepared to provide additional documentation upon request to support medical necessity and coding.
Claims are subject to code edit protocols, claim review, and adjudication per plan documents and provider contracts.

Plan Documents and Acronyms

Plan documents

DefinitionPlan documents include Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents; plan documents govern in case of conflict with this policy.

Governing orderIf a conflict arises between a CPCP and a plan document, the plan document will govern; if a conflict arises between a CPCP and a provider contract, the provider contract will govern.

Interpretation authorityBCBSOK may use reasonable discretion in interpreting and applying this policy and has full and final discretionary authority to the extent provided under applicable plan documents.

CPCP

AcronymCPCP stands for Clinical Payment and Coding Policy (CPCP)

RoleCPCP provides clinical payment and coding guidance used in adjudication of claims and is referenced alongside plan documents and provider contracts.

Interaction with plan documentsIf a conflict arises between a CPCP and any plan document under which a member is entitled to Covered Services, the plan document will govern.