CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABO17

Celiac Disease Testing

Defines Blue Cross Blue Shield of Texas reimbursement criteria for serologic, genetic, and other laboratory tests used to diagnose, confirm, and monitor celiac disease for covered members and participating providers.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyCeliac Disease Testing

Policy CodePolicy CPCPLABO17

Change TypeAdded noncoverage statementsremoved select procedure codesgeneral revisions

Effective DateSep 26, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and code claims per HIPAA-approved code sets; claims are subject to review.

SourceLink

POLICY UPDATE CHANGES

Serologic testing using an HLA-DQ-gluten tetramer-based assay, including flow cytometry-based HLA-DQ-gluten tetramer assays, is not reimbursable.

Codes 81376, 81377, 81382, 81383 were removed from the procedure code list.

Document updated with literature review and changes to Reimbursement Information.

13reimbursement statements

8procedure codes listed

1explicit noncoverage items

multiplereferences cited

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Celiac Testing Coverage Criteria

Celiac testing coverage criteria

Covered when ALL of the following clinical and testing conditions in the policy are met:

ALL of the following

Diagnostic serology (symptomatic)
- For individuals with signs or symptoms of celiac disease (Note 1), serologic testing with IgA anti-tissue transglutaminase (TTG) plus total IgA may be reimbursable.
- For individuals at risk for celiac disease when IgA anti-TTG is negative or weakly positive, IgA endomysial antibody testing may be reimbursable.
IgA deficiency or pediatric exceptions
- For individuals with clinical suspicion and IgA deficiency, testing for IgG endomysial antibodies, IgG deamidated gliadin peptide (DGP), or IgG TTG may be reimbursable.
- Testing for IgA and IgG antibodies to deamidated gliadin peptides (DGP) may be reimbursable for children under 2 years of age with clinical suspicion, and may be used as a substitute for anti-TTG testing in individuals over 2 years of age.
Confirmation
- For confirmation of celiac disease in individuals at high risk, pathological examination (small intestine biopsy) may be reimbursable regardless of serology results.
Monitoring intervals
- For individuals diagnosed with celiac disease who are IgA sufficient: IgA anti-TTG testing may be reimbursable at these intervals: every 6 months until normalization; first follow-up 3 to 6 months after diagnosis; then every 12 to 24 months.
- For individuals diagnosed with celiac disease who are IgA deficient: IgG endomysial, IgG DGP, or IgG TTG testing may be reimbursable at these intervals: every 6 months until normalization; first follow-up 3 to 6 months after diagnosis; then every 12 to 24 months.
Noncoverage rules (not reimbursable)
- Rapid antigen point-of-care testing for anti-TTG is not reimbursable.
- Panel testing, multiplex testing, or multi-analyte testing for more than two analytes for diagnosis or evaluation of celiac disease is not reimbursable.
- Testing is not reimbursable for asymptomatic individuals who are not at increased risk for celiac disease.
- Testing for anti-reticulin antibodies is not reimbursable for diagnosis.
- Testing of stool or saliva samples for evaluation of celiac disease is not reimbursable.
- Serologic testing using an HLA-DQ-gluten tetramer-based assay, including flow cytometry-based HLA-DQ-gluten tetramer assays, is not reimbursable.

Note 1: Signs and symptoms and high-risk groups

Signs and symptoms include but are not limited to chronic or intermittent diarrhea, weight loss, abdominal pain or bloating, recurrent nausea or vomiting, iron deficiency anemia, vitamin B12 or folate deficiency, elevated liver transaminases, autoimmune hepatitis, dermatitis herpetiformis, type 1 diabetes, intestinal blockages, subfertility or miscarriage, osteoporosis/osteomalacia/low bone density, and certain genetic syndromes (Down syndrome, Turner syndrome, Williams‑Beuren syndrome). Pediatric signs may include fatty stools, delayed puberty, amenorrhea, failure to thrive, stunted growth, or short stature.

Procedure Codes and Monitoring Intervals

Procedure codes listed in policyCPT

82784	Tissue transglutaminase antibody
83516	Immunoglobulin A (IgA) quantitative
86231	Endomysial antibody
86255	Deamidated gliadin peptide (DGP) antibody
86256	Deamidated gliadin peptide (DGP) IgG/IgA
86258	Other celiac serology
86364	Antibody testing, other
88305	Pathology, small intestine biopsy

Removed molecular/HLA procedure codes (policy update)CPT

81376
81377
81382
81383

Monitoring intervals — IgA anti-TTG (IgA sufficient)

Routine monitoring cadenceEvery 6 months until anti-TTG levels normalize; then every 12–24 months thereafter.

First follow-up timingFirst post-diagnosis follow-up serology at 3–6 months after diagnosis.

Context of useApplies to individuals diagnosed with celiac disease who are IgA sufficient undergoing IgA anti-TTG testing.

Monitoring intervals — IgG testing (IgA deficient)

Routine monitoring cadenceEvery 6 months until IgG levels normalize; then every 12–24 months thereafter.

First follow-up timingFirst post-diagnosis follow-up serology at 3–6 months after diagnosis.

Documentation and Claim Submission Requirements

Documentation Required

Submit accurate documentation and HIPAA‑approved codes

Providers must submit accurate documentation and use HIPAA‑approved code sets when billing. Claims should be coded per industry standard coding guidelines (for example, CPT, HCPCS, ICD‑10) and providers are responsible for submission of accurate documentation of services and code combinations.

Claims are subject to code edit protocols and claim review, including benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic.
Upon request, providers should submit any additional documentation to support the claim.
If a conflict exists between this policy and a plan document or provider contract, the plan document or provider contract will govern.

Notes and Definitions

Note 1 — Signs and symptoms of celiac disease

Gastrointestinal symptomsUnexplained chronic or intermittent diarrhea; chronic or intermittent abdominal pain or bloating; recurrent nausea or vomiting; fatty stools (pediatrics).

Nutritional/hematologic signsUnexplained weight loss; unexplained iron deficiency anemia; vitamin B12 or folate deficiency; failure to thrive or stunted growth (pediatrics).

Hepatic and dermatologic manifestationsUnexplained liver transaminase elevations; autoimmune hepatitis; dermatitis herpetiformis.

Endocrine/reproductive/bone findingsType 1 diabetes; unexplained subfertility or miscarriage; unexplained osteoporosis, osteomalacia, or low bone density; amenorrhea (pediatrics).

High-risk genetic/chromosomal conditionsIndividuals with Down syndrome, Turner syndrome, or Williams-Beuren syndrome are at increased risk.