CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABO24

Epithelial Cell Cytology in Breast Cancer Risk Assessment

This reimbursement policy governs coverage and billing for cytologic analysis of epithelial cells intended to assess breast cancer risk for members under Blue Cross and Blue Shield of Texas products.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyEpithelial Cell Cytology in Breast Cancer Risk Assessment

Policy CodePolicy CPCPLABO24

Change TypeNo material change

Effective DateJan 1, 2025

Next Review Date

Key ActionSubmit accurate documentation and use valid HIPAA-approved code sets; claims may be reviewed and require additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

not reimbursableReimbursement stance

5Procedure codes listed

01/01/2025Plan effective date

09/13/2024Approval date

Coverage Determination

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Provider Submission and Documentation

Documentation Required

Submit accurate documentation and use valid HIPAA‑approved code sets; claims subject to review

Providers must submit accurate documentation for services performed and code claims using valid HIPAA‑approved code sets and industry standard coding guidelines. Claims are subject to code edit protocols and may be reviewed against benefit terms, provider contracts, medical policies, clinical payment and coding policies, and coding software logic; upon request, providers should submit any additional documentation.

Use valid code combinations from HIPAA‑approved code sets (e.g., CPT, HCPCS, ICD‑10‑CM/PCS) and follow industry standard coding guidelines.
Claims are subject to code edit protocols and claim review; be prepared to provide additional documentation upon request.
Plan documents and provider contracts govern in case of conflict with this policy.

Plan Documents and Contract Precedence

Plan documents / provider contract precedence

Plan documents (examples)Certificates of Health Care Benefits; benefit booklets; Summary Plan Descriptions; other coverage documents

Precedence when conflict existsIf a conflict arises between this Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern

Provider contract precedenceIf a conflict arises between this CPCP and any provider contract under which a provider participates, the provider contract will govern

Interpretation authorityBlue Cross and Blue Shield of TX may use reasonable discretion interpreting and applying this policy and has full and final discretionary authority to the extent provided under any applicable plan documents

Provider responsibilityProviders are responsible for submitting accurate documentation and claims using valid HIPAA‑approved code sets; claims are subject to review and may require additional documentation upon request