CurrentBlue Cross Blue Shield - TexasPolicy CPCPLAB043

Evaluation of Dry Eyes

This Clinical Payment and Coding Policy (Blue Cross Blue Shield - Texas) governs reimbursement for laboratory/point-of-care tests used to evaluate dry eye disease (e.g., tear osmolarity, MMP-9, lactoferrin, IgE) and applies to providers submitting claims under BCBSTX plans.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyEvaluation of Dry Eyes

Policy CodePolicy CPCPLAB043

Change TypeClarified (literature reviewreimbursement unchanged)

Effective DateAug 8, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review.

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review; reimbursement information unchanged; references revised.

New policy created with effective date 01/01/2025 (noted in history).

1test reimbursable (tear osmolarity)

3tests not reimbursable (MMP-9, lactoferrin, IgE)

4procedure codes listed

2025-04-28most recent approval

Reimbursement Criteria

Reimbursement criteria for tear tests

Reimbursement determinations for specific tear tests:

Reimbursement criteria

Tear osmolarity
- Tear osmolarity is reimbursable for individuals suspected of having dry eye
  May be used to monitor effectiveness of therapy or to help determine severity of disease
Not reimbursable tests
- Testing for MMP-9 protein in human tears is not reimbursable for individuals suspected of having dry eye disease based on comprehensive eye examination
- Testing for lactoferrin and/or IgE is not reimbursable for individuals suspected of having dry eye disease

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyEvaluation of Dry Eyes

Policy CodePolicy CPCPLAB043

Change TypeClarified (literature reviewreimbursement unchanged)

Effective DateAug 8, 2025

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review.

SourceLink

On This Page

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.

Procedure Codes and Scope

Listed procedure codes (not all-encompassing; inclusion does not guarantee coverage)CPT

82785
83516
83520
83861

Code list scope

Scope of code listThe procedure code list is not all‑encompassing; inclusion of a code does not guarantee it is a covered service or eligible for reimbursement.

Number of listed codes4 procedure codes are listed in the policy (CPT 82785, 83516, 83520, 83861).

Neutral listing statusCodes are presented for reference; listing is neutral and does not imply automatic coverage—coverage depends on plan terms and criteria.

Provider responsibilityProviders should verify coverage and reimbursement eligibility with the member’s specific plan documents before billing.

Documentation, Claims, and Governance

Documentation Required

Documentation and claim review responsibilities

Providers are responsible for submission of accurate documentation of services performed and must submit claims using valid code combinations from HIPAA-approved code sets. Claims are subject to code edit protocols and review against benefit coverage, provider contracts, medical and clinical payment and coding policies, and coding software logic; upon request, providers should submit additional documentation to support the claim.

Submit claims using valid HIPAA-approved code sets and appropriate industry-standard coding guidelines (e.g., CPT, HCPCS, ICD-10).
Claims are subject to code edit protocols and review against plan benefits, provider contracts, medical policies, and coding logic.
Provide additional documentation upon request to support payment.

Denial Risk

Governance and conflict resolution

If a conflict exists between this Clinical Payment and Coding Policy and a member's plan document or provider contract, the applicable plan document or provider contract governs. BCBSTX may exercise reasonable discretion in interpreting and applying this policy and retains full and final discretionary authority as provided under applicable plan documents.

Plan documents (e.g., Certificates, benefit booklets, Summary Plan Descriptions) control in case of conflict.
Provider contract governs when conflict is between the policy and that contract.
BCBSTX may use reasonable discretion in policy interpretation and application and has final discretionary authority to the extent allowed by plan documents.

OpenPayer

Evaluation of Dry Eyes

Reimbursement Criteria

Procedure Codes and Scope

Documentation, Claims, and Governance

Definitions and Plan-Specific Rules