New Reimbursement Policy: Sexually Transmitted Infections Testing (Professional)

(Effective 01/01/22)

Empire BlueCross BlueShield HealthPlus (Empire) 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 Empire 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: Infectious agent detection by nucleic acid (DNA or RNA); chlamydia trachomatis, amplified probe technique
• 87591: Infectious agent detection by nucleic acid (DNA or RNA); neisseria gonorrhoeae, amplified probe technique
• 87661: Infectious agent detection by nucleic acid (DNA or RNA); trichomonas vaginalis, amplified probe technique

 

Applicable comprehensive code:

• 87801: Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique

 

Empire 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://providerpublic.empireblue.com.

 

NYE-NU-0345-21 August 2021