CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy Sexually Transmitted Infections Testing

Defines BCBSRI reimbursement rules for nucleic acid (DNA/RNA) assays for sexually transmitted infections (specific CPT codes) on professional and facility claims, affecting providers submitting claims 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 changes

Effective DateAug 4, 2025

Next Review DateN/A

Key ActionWhen 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 will be made based on a single unit of CPT 87801.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1 unitPayment basis when two or more single-test CPTs billed

3Single-test CPT codes referenced

87801Comprehensive CPT used for reimbursement

VariesBenefits vary by contract

Reimbursement Rules

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.

Reimbursement criteria for multiple STI tests

Covered when ALL of the following apply:

If two or more single-test CPT codes (87491, 87591, 87661) are billed separately for the same member, by the same provider, on the same date of service, BCBSRI will reimburse based on CPT 87801 (comprehensive multiple-organism code).

Reimbursement will be made based on a single unit of CPT 87801 regardless of the units billed for an individual single-test code; no modifiers will override the bundle edit.

For single-organism testing only, the individual CPT codes 87491 (Chlamydia), 87591 (Gonorrhea), and 87661 (Trichomonas vaginalis) are the appropriate charges when only one organism is tested.

Benefits may vary by group or contract; refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for specific benefit limits or non-covered services.

Medical criteria: Not applicable.

Prior authorization: Not applicable.

Relevant CPT Codes and Payment Rules

STI nucleic acid assay codesCPTCovered

87491	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified technique probe
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

Unit payment rule when multiple single tests billed

Payment basis when multiple single-test CPTs billedIf two or more single-test CPT codes (87491, 87591, 87661) are billed separately by the same provider for the same member on the same date of service, reimbursement will be based on a single unit of CPT 87801.

Units billed for individual single-test codesIrrespective of the quantity of units billed for any individual single-test code, payment will be determined based on a single unit of CPT 87801.

ModifiersNo modifiers will override the bundle edit that requires reimbursement based on CPT 87801 when criteria are met.

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

Charge Types and Test Definitions

Professional vs Facility charges

Professional chargesSubmitted on the CMS-1500 Health Insurance Claim Form or its electronic equivalent.

Facility chargesSubmitted on the UB-04 Claim Form or its electronic equivalent.

ScopePolicy applies to both professional and facility claim forms for nucleic acid (DNA/RNA) assays as outlined in this document.

Comprehensive multiple-organism test (87801)

Definition of CPT 87801Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique — comprehensive multiple-organism test used when multiple single tests are performed.

When to use for reimbursementCPT 87801 is used for reimbursement when two or more single-test codes (87491, 87591, 87661) are billed separately for the same member, by the same provider, on the same date of service.

Reporting requirementReport 1 unit of CPT 87801 when any two or more of codes 87491, 87591, or 87661 are reported.

Relationship to single-test codes87801 is more comprehensive and governs payment regardless of units billed for individual single-test codes.