Diagnostic Testing of Common Sexually Transmitted Infections — Lab Benefit Program (LBM)
Defines coverage criteria and limitations for laboratory diagnostic testing of common STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis, HSV, HPV, Mycoplasma genitalium) under the Lab Benefit Program for EmblemHealth products.
Addition of new Coverage Criteria 23 and removal of CPT code 0167U from Applicable CPT/HCPCS Procedure Codes.
Lab Benefit Program (LBM) expanded to include EmblemHealth HMO/PPO (Non-City) Commercial, Medicare and Medicaid plans effective 10/1/2024.
Trichomonas coverage criteria moved and panels expanded: former Coverage Criteria 10 edited to expand panel coverage to include trichomonas and Mycoplasma genitalium with addition of CPT codes 87563 and 0402U.
Addition of Coverage Criteria 17 & 18 and new subcriteria (c) for Coverage Criteria 2, 5, & 9; Addition of CPT codes 87660, 87661, 87808.
Addition of Note 1 and re-numbering of notes; guidance references T. vaginalis coverage and links to vaginitis policy AHS-M2057.
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.