CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB027

Testing for Diagnosis of Active or Latent Tuberculosis

This reimbursement policy governs when and how laboratory tests for active or latent tuberculosis (TB) may be reimbursed by BCBS Oklahoma and applies to providers submitting claims for covered members under BCBS OK plans.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyTesting for Diagnosis of Active or Latent Tuberculosis

Policy CodePolicy CPCPLAB027

Change TypeNo material change

Effective DateNov 1, 2022

Next Review Date

Key ActionProviders must submit accurate documentation and use valid HIPAA-approved code sets; claims are subject to review and additional documentation may be requested.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

IGRAIGRA reimbursable

AFBAFB smear/stain reimbursable

CultureCulture & susceptibility reimbursable

NAATCertain NAAT reimbursable

Not reimb.Multiple tests not reimbursable

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.

Reimbursable and Non-reimbursable Tests for Tuberculosis

Laboratory and Microbiology Codes

Listed laboratory and microbiology codes referencedmixed

81099
82945
83520
83615
84157
84311
86480
86481
87070
87077

1–10 of 31

1/4

Documentation and Claim Submission Expectations

Documentation Required

Documentation, coding and claim‑review expectations

Providers must submit accurate documentation for services performed and bill using valid HIPAA‑approved code sets; claims are subject to review and may require additional documentation upon request. Claims will be reviewed against plan documents, provider contracts, medical policies, coding edits and code‑edit protocols, and may be denied or adjusted if coding or documentation do not meet those requirements.

Submit claims using valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, NDC, DRG, etc.) and follow industry coding guidelines.
Claims are subject to code‑edit protocols and review against benefit coverage, provider contracts, clinical payment and coding policies, and coding software logic.
Be prepared to provide additional documentation upon request to support medical necessity and correct coding.

Key Test Definitions

inv-04: IGRA — Interferon gamma release assay (IGRA)

DefinitionInterferon gamma release assay (IGRA): A blood test that measures interferon-gamma released from sensitized T-cells to aid in diagnosis or screening for latent tuberculosis infection.

Reimbursable useMay be reimbursable to diagnose or screen for latent tuberculosis infection in individuals at risk or when screening is mandated by law.

Not for active TBGamma interferon blood test is not reimbursable for patients with active tuberculosis.

Documentation requirementProviders must submit accurate documentation and use valid HIPAA-approved code sets when billing for IGRA tests.

inv-05: Nucleic acid-based testing (NAAT/ PCR)

DefinitionNucleic acid-based testing (NAAT/PCR): Direct probe or amplified probe techniques, including PCR, used to detect nucleic acids of Mycobacteria species (e.g., Mycobacteria spp., M. tuberculosis, M. avium intracellulare).