CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO27

Testing for Diagnosis of Active or Latent Tuberculosis

Reimbursement criteria and coding guidance for laboratory testing used to diagnose or screen for active and latent tuberculosis for Blue Cross Blue Shield - Oklahoma plan members; applies to providers submitting claims to BCBSOK.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyTesting for Diagnosis of Active or Latent Tuberculosis

Policy CodePolicy CPCPLABO27

Change TypeAdded NAATprocedure code updatesnomenclature and clarification

Effective Date01/03/2026

Next Review DateN/A

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request; claims are subject to review against plan documents and coding policies.

SourceLink

POLICY UPDATE CHANGES

Qualitative nucleic acid amplification testing (NAAT) for Mycobacteria spp., M. tuberculosis, and M. avium complex was added to Reimbursement Information.

Updated nomenclature from M. avium intracellulare to M. avium complex.

Codes 87564 and 0574U were added to the procedure code list; several older codes (87149, 87550, 87555, 87560) were removed.

For all suspected TB infections, reimbursements may include AFB smear/stain, culture and culture-based drug susceptibility testing, and qualitative NAAT.

1.0policy version

2026-01-03plan effective date

2025-09-26approval date

≥23references

23procedure codes

Coverage and Reimbursement Criteria

TB testing reimbursement criteria

Reimbursement criteria for latent and active TB testing

ALL of the following

ANY of the following
- Screening is required by law (individuals who are unlikely to be infected with M. tuberculosis)
- Individuals who are at risk for infection with Mycobacterium tuberculosis (Mtb)

ALL of the following

ALL of the following
- Acid fast bacilli (AFB) smear/stain

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyTesting for Diagnosis of Active or Latent Tuberculosis

Policy CodePolicy CPCPLABO27

Change TypeAdded NAATprocedure code updatesnomenclature and clarification

Effective Date01/03/2026

Next Review DateN/A

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request; claims are subject to review against plan documents and coding policies.

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 Thresholds

Procedure codes listed in policyCPT

81099
82945
83520
83615
84157
84311
86480
86481
87070
87077

1–10 of 18

1/2

Procedure codes listed in policy (HQ-modifier)Modifier

No codes listed

Foreign residence duration threshold — inv-03

Foreign residence duration>= 1 year living in a foreign country

Context for thresholdApplies when country has at least moderate TB incidence or high MDR-TB prevalence

Use caseCriterion for molecular-based drug susceptibility testing reimbursement when sputum is AFB smear positive or NAAT positive

TB incidence threshold (moderate) — inv-04

TB incidence threshold (moderate)220 per 100,000

Where appliedUsed to define 'moderate' TB incidence for foreign residence criterion

Reimbursement implicationOne of the criteria that may permit molecular-based drug susceptibility testing reimbursement

MDR-TB prevalence threshold (high) — inv-05

MDR-TB prevalence threshold (high)22%

Where appliedUsed to define 'high' primary MDR-TB prevalence for foreign residence criterion

Reimbursement implicationMeeting this threshold for a country may justify molecular-based drug susceptibility testing reimbursement

Provider Responsibilities and Billing Notices

Documentation Required

Documentation and claims review — Providers must submit accurate documentation

Providers are responsible for submission of accurate documentation of services performed and must code claims using valid HIPAA-approved code sets. Claims should follow industry-standard coding guidelines, including but not limited to the Uniform Billing Editor, American Medical Association CPT resources, HCPCS, ICD-10-CM/PCS, National Drug Codes, DRG guidelines, CMS NCCI Policy Manual, and applicable CCI table edits. Claims are subject to code edit protocols and payer claim-review processes.

Submit claims using valid HIPAA-approved code sets (CPT, HCPCS, ICD-10, NDC, DRG).
Follow industry coding guidance (AMA CPT, CMS NCCI, CCI table edits).

Note

Payer discretion and precedence — BCBSOK retains discretionary authority

Claims are subject to review against benefit coverage, provider contract terms, medical and clinical payment and coding policies, and automated coding/software logic. BCBSOK may request additional documentation from the provider; upon request, providers should promptly submit supporting records to facilitate claim adjudication. In case of conflict between this policy and a plan document or provider contract, the plan document or contract governs. Blue Cross and Blue Shield of Oklahoma retains discretion to interpret and apply this policy.

Claims may be reviewed for coding edits, benefit limits, and contract terms.
Providers may be asked to provide additional documentation upon request — respond promptly.
Plan documents and provider contracts take precedence over this policy when conflicts arise.
BCBSOK retains discretion to interpret and apply this policy.

Key Terms and Test Definitions

IGRA — inv-08

DefinitionInterferon gamma release assay (IGRA)

Primary useMay be reimbursable to diagnose or screen for latent TB infection in individuals at risk or when screening is required by law

LimitationNot reimbursable for individuals with active tuberculosis

NAAT — inv-09

DefinitionNucleic acid amplification testing (NAAT) for Mycobacteria, including M. tuberculosis and M. avium complex

Primary useQualitative NAAT may be reimbursable for suspected TB infections

LimitationQuantitative NAAT for Mycobacterium spp., M. tuberculosis, and M. avium complex is not reimbursable

AFB smear / culture with DST — inv-10

DefinitionAcid fast bacilli (AFB) smear/stain and culture with culture-based drug susceptibility testing

Primary useMay be reimbursable for all suspected TB infections

Follow-up testingMolecular-based drug susceptibility testing may be reimbursable when sputum is AFB smear positive or NAAT positive and additional risk criteria are met

LAM urine test — inv-11

DefinitionUrine-based lipoarabinomannan (LAM) testing

Indicated populationHIV-infected individuals with CD4 <100 cells/microL who have signs and symptoms of tuberculosis

Reimbursement stanceMay be reimbursable in the specified HIV-infected population