CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB042

ZIKA Virus Risk Assessment

Defines BCBS Oklahoma reimbursement criteria for Zika virus laboratory testing (RNA NAT and IgM) including which patient groups and specimen types may be reimbursable and which are not; applies to providers submitting claims to BCBSOK.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyZIKA Virus Risk Assessment

Policy CodePolicy CPCPLAB042

Change TypeNo material change

Effective DateNov 1, 2022

Next Review Date

Key ActionProviders must 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.

Infants & select maternal/fetal casesReimbursable situations

Symptomatic nonpregnant; asymptomatic; preconceptionNot reimbursable

Serum, urine, CSF, amniotic/placental/fetalSpecimen types

2022Policy effective

Reimbursement Criteria for Zika Virus Testing

Reimbursement criteria for Zika virus testing

BCBSOK reimbursement stance for Zika virus testing by test type, patient group, and specimen:

ANY of the following

Infants with clinical findings consistent with congenital Zika syndrome and possible maternal Zika virus exposure during pregnancy
Reimbursable regardless of maternal testing results
Infants without clinical findings consistent with congenital Zika syndrome born to mothers with laboratory evidence of possible Zika virus infection during pregnancy

Reimbursement may be considered for Zika virus RNA NAT testing of amniocentesis, placental, and fetal tissues

For pregnant women with possible exposure who have a fetus with prenatal ultrasound findings consistent with congenital Zika virus infection and who are undergoing amniocentesis

ANY of the following

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyZIKA Virus Risk Assessment

Policy CodePolicy CPCPLAB042

Change TypeNo material change

Effective DateNov 1, 2022

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

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.

Documentation and Claim Submission Expectations

Documentation Required

Documentation and claim submission expectations

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. Claims are subject to code edit protocols and clinical review; upon request, providers must submit additional documentation. Plan documents and provider contracts govern if they conflict with this policy.

Submit claims using valid HIPAA‑approved code sets and industry standard coding guidelines (e.g., UB, CPT, HCPCS, ICD‑10).
Claims are subject to code edit protocols, coding software logic, and clinical/benefit review.
Be prepared to provide additional documentation upon request.
When conflicts exist, plan documents or provider contracts take precedence over this policy.

Policy Scope and Coding Standards

Reimbursement criteria and coding requirements for Zika virus testing

Governing precedencePlan documents and provider contracts take precedence over this policy when conflicts arise; plan documents include Certificates, benefit booklets, Summary Plan Descriptions, and other coverage documents.

Coding and code set expectationsClaims must be submitted using valid combinations from HIPAA‑approved code sets and coded according to industry standard coding guidelines (e.g., UB, AMA/CPT, HCPCS, ICD‑10, NDC, DRG, CMS NCCI/CCI edits).

Claim review and documentationClaims are subject to code edit protocols and claim review; providers must submit accurate documentation and may be asked to provide additional documentation upon request.

Policy interpretation authorityBCBSOK may use reasonable discretion in interpreting and applying this policy and retains final discretionary authority to the extent provided under applicable plan documents.

Scope noteThis policy implements lab management reimbursement criteria; not all requirements apply to each product — providers should review specific plan documents for eligible coverage.

OpenPayer

ZIKA Virus Risk Assessment

Reimbursement Criteria for Zika Virus Testing

Coding Guidance and Code Sets

Documentation and Claim Submission Expectations

Policy Scope and Coding Standards