CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy Sexually Transmitted Infections Testing

Reimbursement rules for nucleic acid (DNA/RNA) testing for sexually transmitted infections submitted by professional and facility providers to Blue Cross Blue Shield of Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPayment Policy Sexually Transmitted Infections Testing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateAug 4, 2025

Next Review DateN/A

Key ActionReport a single unit of CPT code 87801 when two or more single-test CPT codes (87491, 87591, 87661) are billed by the same provider for the same member on the same date of service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

87801 bundledReimbursement approach

1 unitRequired reporting

3 codesSingle-test codes

Professional & facilityClaim types

Coverage and Reimbursement Criteria

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If two or more single-test CPT codes (87491, 87591, 87661) are billed by the same provider for the same member on the same date of service, BCBSRI will reimburse based on a single unit of CPT code 87801; no modifiers override the bundle edit.

Report 1 unit of CPT code 87801 when any two or more single-test codes (87491, 87591, 87661) are reported.

Benefits may vary by group/contract; refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for coverage specifics.

No prior authorization is required and no specific medical necessity criteria apply to this bundling/reimbursement rule.

STI Nucleic Acid Test Codes and Billing Rules

Covered CPT CodesCPTCovered

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
87801	Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique

inv-03: Bundling rule — when two or more single-test codes (87491, 87591, 87661) are billed by same provider for same member on the same date of service.

Bundling ruleWhen two or more single-test CPT codes (87491, 87591, 87661) are billed by the same provider for the same member on the same date of service, reimbursement is based on a single unit of CPT code 87801; no modifiers will override the bundle edit.

Reimbursement unitReimbursement will be made based on a single unit of CPT code 87801 regardless of the units billed for a single code.

Applicable single-test codes87491 (Chlamydia), 87591 (Neisseria gonorrhoeae), 87661 (Trichomonas vaginalis).

Multiple-organism code87801 is the more comprehensive code used when multiple single-test codes are reported.

Reporting requirementReport 1 unit of 87801 when any two or more single-test codes (87491, 87591, 87661) are reported.

Submission Types and Charge Definitions

inv-05: Professional charges — submitted on CMS-1500 or electronic equivalent.

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

Applies toProfessional claim submissions for nucleic acid STI testing covered by this policy.

ReferenceSee policy overview for claim form guidance and reimbursement rules.

inv-06: Facility charges — submitted on UB-04 or electronic equivalent.

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

Applies toFacility claim submissions for nucleic acid STI testing covered by this policy.