CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Medical Coverage Policy Salivary Estriol as Risk Predictor for Preterm Labor and Management of Menopause and/or Aging

Defines coverage position for salivary hormone testing (including salivary estriol/SalEst) for predicting preterm labor and for management of menopause/aging for BCBSRI commercial and Medicare Advantage products. States tests are not covered/not medically necessary due to insufficient evidence.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMedical Coverage Policy Salivary Estriol as Risk Predictor for Preterm Labor and Management of Menopause and/or Aging

Policy CodePolicy N/A

Change TypeNo material change

Effective DateDec 18, 2003

Next Review Date

Key ActionSubmitters should expect that salivary hormone tests (including S3650 and S3652) will be considered not medically necessary and are not covered; check member benefit booklet as benefits may vary by contract.

SourceLink

POLICY UPDATE CHANGES

No material changes — policy remains not covered / not medically necessary for salivary hormone testing.

2HCPCS codes not covered

2Primary indications denied

Coverage Summary

Salivary hormone testing (including salivary estriol/SalEst) is considered not covered / not medically necessary for predicting preterm labor and for diagnosis, treatment, or monitoring of menopause/aging for BCBSRI Commercial and Medicare Advantage products. The policy lists HCPCS codes S3650 and S3652 as not covered. This policy has an effective date of 12/18/2003 and was last reviewed/updated on 10/19/2022. Benefits may vary by contract.

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Medical Necessity / Not Medically Necessary Criteria

Coverage Determination

The use of salivary hormone testing is considered not covered / not medically necessary when used for the following:

ANY of the following

Salivary hormone testing to diagnose, treat, or monitor menopause or aging (including tests for estrogens, progesterone, testosterone, melatonin, cortisol, DHEA and others).
Commercial Products: considered not medically necessary.
Salivary estriol testing (e.g., SalEst) to assess risk of preterm labor or delivery in pregnant women.
No clinical studies showing that treatment decisions based on salivary results produce beneficial health outcomes; considered not medically necessary.

Provider Actions & Billing Impact

Denial Risk

Claims for salivary hormone testing will be denied/not covered

Submitters should expect that salivary hormone tests (including S3650 and S3652) will be considered not medically necessary and are not covered; benefits may vary by contract so check member benefit booklet.

S3650
S3652

Providers should check the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for contract-specific coverage and applicable exceptions, because benefits may vary between groups and contracts. Claims for salivary hormone tests (including HCPCS codes S3650 and S3652) are expected to be denied/not covered per this policy; confirm coverage before ordering or billing.

Background & Evidence

Salivary hormone tests are commercially available for a number of hormones (including estrogens, progesterone, testosterone, melatonin, cortisol, and DHEA) and are sometimes marketed direct-to-consumer. Major professional organizations (ACOG, FDA, NAMS, ICSI, AACE) have issued statements raising concerns about the validity and reliability of salivary hormone assays. The SalEst system is an FDA-cleared laboratory technique for measuring salivary estriol and is indicated for use every 1 to 2 weeks in singleton pregnancies between 22 and 36 weeks; however, no clinical studies demonstrate that treatment decisions based on salivary hormone results improve health outcomes, and therefore use of salivary testing is considered not medically necessary.

Evidence

Definitions