CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABO48

Folate Testing

Laboratory reimbursement criteria for folate testing for Blue Cross and Blue Shield of Texas members; indicates when measurement of serum folate is reimbursable and which folate-related tests are not reimbursable. Applies to providers submitting claims to BCBSTX plans (review plan documents for product-specific applicability).

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyFolate Testing

Policy CodePolicy CPCPLABO48

Change TypeRevised — reimbursement criteria expandedreferences updated

Effective DateJul 25, 2025

Next Review DateN/A

Key ActionSubmit supporting documentation upon request to support medical necessity and coding; review plan documents for product-specific coverage requirements.

SourceLink

POLICY UPDATE CHANGES

Reimbursement criteria updated to allow serum folate testing for all types of anemia (megaloblastic or macrocytic) and for individuals who have undergone or are scheduled for bariatric procedures; a former exclusion (#2) was deleted.

Policy versioning and effective/plan effective dates were added (Version 1.0; Approval Date 2025-07-25; Plan Effective Date 2025-11-07).

3Procedure codes listed

serum reimbursableTest coverage stance

RBC folateTest exclusion

Folate receptor autoantibodyTest exclusion

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyFolate Testing

Policy CodePolicy CPCPLABO48

Change TypeRevised — reimbursement criteria expandedreferences updated

Effective DateJul 25, 2025

Next Review DateN/A

Key ActionSubmit supporting documentation upon request to support medical necessity and coding; review plan documents for product-specific coverage requirements.

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.

When Serum Folate Testing Is Reimbursable

Reimbursement criteria for serum folate concentration

Measurement of serum folate concentration may be reimbursable in any of the following situations; all other indications are not reimbursable.

ANY of the following

For individuals with megaloblastic or macrocytic anemia.
For individuals who have undergone, or who have been scheduled for, bariatric procedures such as Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion/duodenal switch.

ALL of the following

For all indications not described above, measurement of serum folate concentration is not reimbursable.
For all indications, measurement of red blood cell (RBC) folate is not reimbursable.
For all situations, folate receptor autoantibody testing is not reimbursable.

Procedure Codes Referenced

Procedure codes mentionedmixed

82746	Folate; serum
82747	Folate; red blood cell
0399U	Folate receptor autoantibody (FDA-defined PLA code) or other proprietary code (as listed)

Procedure codes mentionedmixed

82746	Folate; serum
82747	Folate; red blood cell
0399U	Folate receptor autoantibody (FDA-defined PLA code) or other proprietary code (as listed)

Billing, Documentation, and Prior Authorization Notes

Documentation Required

Submit supporting documentation upon request

Claims are subject to claim review and providers are urged to submit any additional documentation upon request to support medical necessity and coding.

Billing Rule

Code set and coding guideline compliance

Providers are responsible for submission of accurate documentation and use of HIPAA‑approved code sets; claims should be coded according to industry standard coding guidelines (CPT, HCPCS, ICD‑10, NDC, UB, CCI edits, etc.).

Scope and Rationale

This policy defines laboratory reimbursement criteria for folate testing for Blue Cross and Blue Shield of Texas (BCBSTX) members. It specifies when measurement of serum folate concentration may be reimbursable and identifies folate-related tests that are not reimbursable. The guidance applies to providers submitting claims to BCBSTX plans; providers should review plan documents for product-specific applicability and any prior authorization requirements.

The policy was updated with a literature review and revisions effective July 25, 2025. Reimbursement criteria were expanded to allow serum folate testing for megaloblastic or macrocytic anemia and for individuals who have undergone or are scheduled for bariatric procedures (for example, Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion/duodenal switch); a former exclusion was deleted. The references supporting the policy (NIH, clinical guidelines, reviews, and specialty society guidance) were revised as part of the July 25, 2025 update.

Defined Terms

Definitions

TermPlan documents

DefinitionCertificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents that govern member entitlement to covered services.

Governing ruleIf a conflict arises between a Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern.

Document Update History

2025-07-25Policy updateLatest

Document updated with literature review; reimbursement information revised to allow serum folate testing for megaloblastic/macrocytic anemia and for individuals who have undergone or are scheduled for bariatric procedures; a former exclusion was deleted; references revised. Plan Effective Date 2025-11-07.

2024-09-13New policy

New policy established (history lists Effective Date 01/01/2025).