CurrentBlue Cross Blue Shield - TexasPolicy CPCPLAB014

Prenatal Screening (Nongenetic)

Reimbursement and lab management criteria for routine non-genetic prenatal screening tests for pregnant individuals covered by Blue Cross Blue Shield of Texas.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyPrenatal Screening (Nongenetic)

Policy CodePolicy CPCPLAB014

Change TypeRevised code list and testing recommendations

Effective DateJan. 3, 2026

Next Review Date

Key ActionSubmit accurate documentation for claims and be prepared to provide additional documentation upon request; claims are subject to code edit protocols and review against plan terms.

SourceLink

POLICY UPDATE CHANGES

Updated recommended testing type for HIV, Hep B, and Hep C; edited wording for N. gonorrhoeae and Group B streptococcal screening timing; clarified FFN coverage in ambulatory setting; removed redundant statement regarding FFN.

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

Added code 87389 and removed several listed codes (83020, 83021, 85048, 86701, 86702, 86703, G0432, G0433, G0435).

Removed code 87592.

15+Procedure codes listed

1.0Policy version

Jan. 3, 2026Plan effective date

09/26/2025Last review

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyPrenatal Screening (Nongenetic)

Policy CodePolicy CPCPLAB014

Change TypeRevised code list and testing recommendations

Effective DateJan. 3, 2026

Next Review Date

Key ActionSubmit accurate documentation for claims and be prepared to provide additional documentation upon request; claims are subject to code edit protocols and review against plan terms.

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.

Prenatal screening coverage criteria

Reimbursable routine prenatal screening tests and conditional services

ALL of the following

ANY of the following
- Antigen/antibody combination assay screening for HIV infection
- Screening for Chlamydia trachomatis infection
- Screening for Neisseria gonorrhoeae infection
- Triple panel screening for hepatitis B (HBsAg, anti-HBs, total anti-HBc)
- Screening for syphilis
- Antibody screening for hepatitis C
- Screening for type 2 diabetes at the first prenatal visit
- Screening for gestational diabetes during gestational weeks 24 - 28 and at the first prenatal visit if risk factors are present
- Determination of blood type, Rh(D) status, and antibody status during the first prenatal visit; repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative individuals at 24 to 28 weeks' gestation unless the biological father is known to be Rh (D)-negative
- Screening for anemia with a CBC or hemoglobin and hematocrit with mean corpuscular volume
- Screening for Group B streptococcal disease (once per pregnancy recommended during gestational weeks 36 to 37)
- Urinalysis and urine culture
- Rubella antibody testing
- Testing for varicella immunity
- Screening for tuberculosis in pregnant individuals deemed to be at high risk for TB

Third trimester re-screening: Individuals less than 25 years of age or continued high risk (e.g., new or multiple sex partners, history of STIs, past or current drug use). May be reimbursable for re-screening of Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and/or HIV.

Rapid HIV testing in labor: Pregnant individuals presenting in active labor with undocumented HIV status. May be reimbursable.

Fetal fibronectin (FFN): Pregnant individuals with singleton or twin pregnancies presenting in the ambulatory setting with signs or symptoms of preterm labor. May be reimbursable (FFN reimbursable only in symptomatic ambulatory presentations).

Not reimbursable services: For individuals with a normal pregnancy without complications, human chorionic gonadotropin (hCG) hormone testing is not reimbursable; serial monitoring of salivary estriol levels for risk assessment of preterm labor or delivery is not reimbursable.

Procedure Codes and Coding Notes

Examples of listed procedure codesmixed

80055
G0306
S3652

Full code list (source contains additional codes)mixed

80081
81001
81002
81003
81007
81015
82677
82731
82947
82950

1–10 of 62

1/7

Code list completeness note

Scope of listThe procedure code list is not all‑encompassing — it is a sample of codes related to prenatal screening.

No guarantee of coverageInclusion of a code in the list does not guarantee it is a covered service or eligible for reimbursement.

Claims subject to reviewCodes must be billed using valid HIPAA‑approved code sets and are subject to coding edits and claim review against plan terms and policies.

Documentation, Claims, and Conditional Coverage Actions

Documentation Required

Documentation and claim review

Providers must submit accurate documentation of services performed and code claims using valid HIPAA-approved code sets. Claims are subject to code edit protocols and review against plan and contract terms, and upon request providers should submit additional documentation to support the claim.

Submit claims coded appropriately according to industry-standard coding guidelines (UB, AMA CPT, HCPCS, ICD-10, NDCs, DRG, CCI edits).
Be prepared to provide additional documentation upon request to support medical necessity and coding.

Note

Coverage conditional actions for specific tests

Certain prenatal screening tests are reimbursable only when specific clinical conditions are met (for example, FFN only for symptomatic patients in the ambulatory setting; rapid HIV testing for individuals in active labor with undocumented HIV status).

Fetal fibronectin (FFN) may be reimbursable only for pregnant individuals with singleton or twin pregnancies presenting in the ambulatory setting with signs or symptoms of preterm labor.
Rapid HIV testing may be reimbursable for pregnant individuals who present in active labor with an undocumented HIV status.
Third-trimester re-screening for chlamydia, gonorrhea, syphilis, and/or HIV may be reimbursable only for individuals <25 years or those at continued high risk of infection.

Plan Documents and Covered Services

Plan documents

DefinitionPlan documents include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

HierarchyIf a conflict exists between this Clinical Payment and Coding Policy and a member's plan document, the plan document governs.

Provider contractsIf a conflict exists between this policy and any provider contract, the provider contract governs.

Covered Services

DefinitionCovered Services are services provided to eligible members as described in applicable plan documents and provider contracts; plan documents govern coverage determinations.

Billing requirementProviders must submit accurate documentation and use valid HIPAA‑approved code sets when billing for Covered Services.

Claim reviewClaims for Covered Services are subject to code edit protocols and review against benefit coverage, provider contract language, medical and coding policies.

OpenPayer

Prenatal Screening (Nongenetic)

Prenatal Screening Coverage Criteria

Procedure Codes and Coding Notes

Documentation, Claims, and Conditional Coverage Actions

Plan Documents and Covered Services