CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy | Sexually Transmitted Infections Testing

Governs reimbursement rules for nucleic acid assays (CPT 87491, 87591, 87661, 87801) for sexually transmitted infections on professional and facility claims for Blue Cross Blue Shield - Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPayment Policy | Sexually Transmitted Infections Testing

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 4, 2025

Next Review DateN/A

Key ActionWhen two or more single-test CPT codes are billed by the same provider on the same date of service, reimbursement is made as a single unit of CPT 87801.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4STI-related codes discussed

1-unitBundling payment rule

MA & CommercialPlan types

NonePrior auth

Reimbursement Criteria

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ALL of the following

Two or more single-test CPT codes (87491, 87591, and/or 87661) are billed separately for the same member by the same provider on the same date of service.
When the above condition is met, BCBSRI will reimburse based on the more comprehensive multiple-organism code CPT 87801.
Reimbursement will be made based on a single unit of CPT 87801 regardless of the units billed for any single code.
No modifier will override the bundle edit; the bundle stands even if modifiers are appended to single-test codes.
Operational note: Providers must still bill for the applicable single STI CPT codes as rendered; payment will be adjusted to a single unit of 87801 per policy. Benefits may vary by contract; refer to member benefit documents for coverage determinations.

CPT Codes and Coding Rules

Single-organism STI nucleic acid testsCPTCovered

87491	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique
87591	Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique
87661	Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique

Comprehensive/multiple-organism testCPTCovered

87801

Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique

Reimbursement bundling rule

Rule summaryWhen two or more single-test CPT codes (87491, 87591, 87661) are billed separately by the same provider on the same date of service, reimbursement is based on a single unit of CPT 87801.

ScopeApplies to Medicare Advantage and Commercial products for BCBSRI; applies to professional and facility claims.

Units and modifiersPayment is based on a single unit of 87801 regardless of units billed for a single code; no modifier will override the bundle edit.

Covered single-test codes referencedCPT 87491, 87591, 87661 (single-organism nucleic acid tests).

Charge Definitions

Professional charges

DefinitionProfessional charges are charges submitted on a CMS-1500 (1500 Health Insurance Claim Form) or electronic equivalent.

Typical submitterServices billed by individual practitioners (physicians, labs billing professional component) on CMS-1500.

Claim formCMS-1500 (1500 Health Insurance Claim Form) or electronic equivalent.

Facility charges

DefinitionFacility charges are charges submitted on a UB-04 Claim Form or electronic equivalent.

Typical submitterHospitals and facility-based outpatient departments submitting institutional claims on UB-04.

Claim formUB-04 Claim Form or electronic equivalent.