New policy: Sexually transmitted infections testing, effective January 2022 - professional

Anthem Blue Cross (Anthem) allows reimbursement of sexually transmitted infection (STI) tests unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise. We consider certain STI testing CPT^® codes to be part of a laboratory panel grouping. When Anthem receives a claim with two or more single tests laboratory procedure codes reported, we will bundle those two or more single tests into the comprehensive laboratory procedure code listed below.

Applicable single STI CPT codes:

• 87491: Chlamydia trachomatis
• 87591: Neisseria gonorrhoeae
• 87661: Trichomonas vaginalis

 

Applicable comprehensive code:

 

• 87801: Comprehensive multiple organism code

 

Anthem will reimburse the more comprehensive, multiple organism code for infectious agent detection by nucleic acid, amplified probe technique (CPT code 87801), when two or more single test CPT codes are billed separately by the same provider on the same date of service. Reimbursement will be made based on a single unit of CPT code 87801 regardless of the units billed for a single code. No modifiers will override the edit.

 

For additional information, please review the Sexually Transmitted Infections Testing — Professional reimbursement policy at https://providers.anthem.com/ca.

 

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