ModifiedBlue Cross Blue Shield - OklahomaPolicy CPCPLAB027

Testing for Diagnosis of Active or Latent Tuberculosis

This Clinical Payment and Coding Policy governs reimbursement criteria for laboratory testing used to diagnose or screen for active and latent tuberculosis for Blue Cross Blue Shield - Oklahoma members; it affects providers submitting claims for TB-related laboratory services.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyTesting for Diagnosis of Active or Latent Tuberculosis

Policy CodePolicy CPCPLAB027

Change TypeNAAT addeddirect probe testing and legacy codes removed/updated

Effective DateSep 26, 2025

Next Review Date

Key ActionSubmit accurate documentation and update claims to reflect added NAAT codes (87564, 0574U) and removal of legacy codes.

SourceLink

POLICY UPDATE CHANGES

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

Direct probe testing is no longer available and was removed from the reimbursement list.

Replaced 'Hologic Amplified MTD' terminology with 'NAAT' for clarity in the reimbursement list.

Updated naming from 'M. avium intracellulare' to 'M. avium complex' to align with naming conventions.

Codes 87564 and 0574U were added to the policy; codes 87149, 87550, 87555, 87560 were removed.

10+enumerated reimbursable and non-reimbursable tests and codes listed

2NAAT-related codes added (listed)

2recent policy update entries shown

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Coverage Criteria for TB Testing

TB testing reimbursement criteria

Reimbursable and non-reimbursable TB tests and the clinical criteria that determine reimbursement.

ALL of the following

Reimbursable when used to diagnose or screen for latent tuberculosis (TB) infection in individuals who are at risk for infection with Mycobacterium tuberculosis (Mtb) or when screening is required by law (individuals unlikely to be infected).
Not reimbursable when used to diagnose active tuberculosis.

ALL of the following

Acid-fast bacilli (AFB) smear/stain may be reimbursable.
Culture and culture-based drug susceptibility testing of Mycobacteria species may be reimbursable.
Qualitative nucleic acid amplification testing (NAAT) for Mycobacteria spp., M. tuberculosis, and M. avium complex may be reimbursable; quantitative NAAT is not reimbursable.

ALL of the following

Applies when an individual’s sputum is AFB smear positive or NAAT positive.
AND when one of the following is present:
- Prior TB treatment (individual has been treated for TB in the past).
- Born in or lived for ≥1 year in a foreign country with TB incidence ≥20 per 100,000 or MDR-TB prevalence ≥2%.
- Contact of an individual with MDR-TB.
- HIV infection.

ALL of the following

Reimbursable in any of the following:
- When sputum cultures remain positive after 3 months of treatment.
- When there is bacteriological reversion from negative to positive.

ALL of the following

For individuals with pleural effusion, pericardial effusion, or ascites and suspected TB, cell counts, protein, glucose, and lactate dehydrogenase (LDH) concentrations of cerebrospinal, pleural, peritoneal, pericardial, and other fluids may be reimbursable.

ALL of the following

Reimbursable for HIV-infected individuals with CD4 cell counts ≤100 cells/µL who have signs and symptoms of tuberculosis.

Not reimbursable tests (exclusions)

IGRA for individuals with active tuberculosis (not reimbursable).
Quantitative nucleic acid testing for Mycobacterium spp., M. tuberculosis, and M. avium complex (not reimbursable).
Testing of adenosine deaminase (ADA) and interferon-gamma (IFNγ) levels in cerebrospinal, pleural, peritoneal, pericardial, and other fluids for extrapulmonary TB diagnosis (not reimbursable).
Testing of serum protein biomarkers or panels for detection and diagnosis of TB (not reimbursable).

Recent reimbursement updates

Reimbursement information was updated to add NAAT and adjust test lists and codes.

ALL of the following

Qualitative nucleic acid amplification testing (NAAT) for Mycobacteria spp., M. tuberculosis, and M. avium complex was added to the reimbursable tests list; direct probe testing (including prior 'Hologic Amplified MTD' terminology) is no longer available and was removed.
Naming updated from 'M. avium intracellulare' to 'M. avium complex' for alignment with current conventions.

ALL of the following

Codes 87564 and 0574U were added to the policy's coding list for NAAT.
Codes removed: 87149, 87550, 87555, 87560 (legacy/direct probe-related codes).

Procedure and Lab Codes

Procedure/Lab codes referencedCPT

81099
82945
83520
83615
84157
84311
86480
86481
87070
87077

1–10 of 29

1/3

recently added and removed codesmixed

87564	NAAT (added per policy update)
0574U	NAAT (added per policy update)
87149	Code removed (previous direct probe or other test)
87550	Code removed
87555	Code removed
87560	Code removed

Foreign country residence threshold for MDR/TB risk

Foreign residence durationLived for at least 1 year in a foreign country

TB incidence thresholdCountry with TB incidence ≥20 per 100,000

MDR-TB prevalence thresholdCountry with primary multi-drug resistant (MDR) TB prevalence ≥2%

Code changes effective

Policy Update effective date09/26/2025

Summary of changes effectiveSummary of Changes = 01/03/2026 (document update/literature review)

Provider Responsibilities and Actionable Notes

Documentation Required

Documentation and claim review responsibilities

Providers are responsible for submission of accurate documentation of services performed and for coding claims using valid HIPAA-approved code sets per industry standards (e.g., UB, AMA CPT, HCPCS, ICD-10-CM/PCS). Claims are subject to code edit protocols and claim review against benefit terms, provider contracts, medical policies, clinical payment and coding policies, and coding software logic. Upon request, providers must submit any additional documentation to support the claim.

Providers must submit claims using valid code combinations from HIPAA-approved code sets and follow industry-standard coding guidelines.
Claims are subject to claim review and may be adjusted or denied if documentation or coding is insufficient; providers may be asked to supply additional documentation.

Billing Rule

Coding changes and reimbursement list update

Definitions and Test Descriptions

IGRA (Interferon Gamma Release Assay)

TestInterferon gamma release assay (IGRA) — blood-based test for latent TB infection

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

Not reimbursable useNot reimbursable for individuals with active tuberculosis

Standard microbiologic tests for suspected active TB

Primary testsAcid-fast bacilli (AFB) smear/stain; culture and culture-based drug susceptibility testing of Mycobacteria spp.

Reimbursable contextMay be reimbursable for all suspected TB infections per clinical criteria

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyTesting for Diagnosis of Active or Latent Tuberculosis

Policy CodePolicy CPCPLAB027

Change TypeNAAT addeddirect probe testing and legacy codes removed/updated

Effective DateSep 26, 2025

Next Review Date

Key ActionSubmit accurate documentation and update claims to reflect added NAAT codes (87564, 0574U) and removal of legacy codes.

SourceLink

On This Page

Notable action on this date

Added qualitative NAAT; removed direct probe testing; added codes 87564 and 0574U; removed codes 87149, 87550, 87555, 87560

Policy Update History indicates coding and reimbursement updates effective 09/26/2025. Specifically, codes 87564 and 0574U were added to the reimbursable code set and codes 87149, 87550, 87555, and 87560 were removed as part of this update. Providers should use the current reimbursable code list when billing and expect that prior removed direct probe test codes are no longer reimbursable.

Effective 09/26/2025: Added codes 87564, 0574U.
Effective 09/26/2025: Removed codes 87149, 87550, 87555, 87560.
Providers should bill using the updated codes and verify reimbursement status prior to claim submission.

Note

Test availability change

Qualitative NAAT for Mycobacteria spp., M. tuberculosis, and M. avium complex has been added to reimbursable tests; direct probe testing was removed because it is no longer available. Providers should order and bill for NAAT-based tests using the updated codes and test descriptors.

Added reimbursable test: Qualitative nucleic acid amplification testing (NAAT) for Mycobacteria spp., M. tuberculosis, and M. avium complex.
Direct probe testing removed from reimbursable list.

Follow-upMolecular-based drug susceptibility testing may be reimbursable if sputum is AFB smear positive or NAAT positive and additional criteria met

Urine LAM assay

TestUrine-based detection of lipoarabinomannan (LAM)

Reimbursable populationHIV-infected individuals with CD4 cell counts ≤100 cells/µL who have signs and symptoms of tuberculosis

Clinical indicationUsed to aid diagnosis in symptomatic, severely immunocompromised HIV-infected persons

Qualitative NAAT

TestQualitative nucleic acid amplification testing (NAAT) for Mycobacteria spp., M. tuberculosis, and M. avium complex

Reimbursable contextMay be reimbursable for suspected TB infections (qualitative NAAT only); quantitative NAAT is not reimbursable

Policy update noteNAAT was explicitly added to Reimbursement Information in the 09/26/2025 update

Direct probe testing (removed)

Test type removedDirect probe testing (older molecular direct probe methods) is no longer available and was removed from the reimbursement list

ReplacementDirect probe testing was operationally replaced by qualitative NAAT in the reimbursement information

Coding impactLegacy codes associated with removed methods (e.g., 87149, 87550, 87555, 87560) were removed per policy update