Empire and Anthem BCBS – Reimbursement Policy Update: Sexually Transmitted Infections Testing (Professional)

Sep 1, 2021 • Policy Updates / Reimbursement Policies

Material adverse change (MAC) notification.

Beginning with dates of service on or after December 1, 2021, Empire BlueCross BlueShield (“Empire”) will implement a new reimbursement policy titled Sexually Transmitted Infections Testing.  Empire considers Sexually Transmitted Infection (STI) testing CPT® codes 87491, 87591, and 87661 to be part of a laboratory panel grouping. When two or more of single test laboratory procedure codes are reported on a claim by the same provider on the same date of service, the codes will be bundled into the comprehensive laboratory procedure code 87801. Empire will reimburse the more comprehensive, multiple organism CPT ®code 87801 when two or more single tests 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. The provider is required to bill for the applicable single STI CPT codes as rendered and the comprehensive CPT code will be reimbursed. Modifiers will not override this edit.