Published May 27, 2025 (Updated June 6, 2025)
Coding and Compensation Policies describe payment rules and methodologies for Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies. It’s not intended to address all reimbursement-related issues. We regularly add and modify coding and compensation policy positions as part of our ongoing policy review process.
The following new policy was implemented:
- Global OB Maternity Services Policy, effective Aug. 19, 2025
The following policies were updated:
- CPCPLAB001 Flow Cytometry, effective Aug. 8, 2025
- CPCPLAB006 Prostate Specific Antigen Testing, effective Aug. 8, 2025
- CPCPLAB011 Biomarker Testing for Autoimmune Rheumatic Disease, effective Aug. 8, 2025
- CPCPLAB013 Allergen Testing, effective Aug. 8, 2025
- CPCPLAB014 Prenatal Screening (Nongenetic), effective Aug. 8, 2025
- CPCPLAB016 Pediatric Preventative Screening, effective Aug. 8, 2025
- CPCPLAB018 Helicobacter Pylori Testing, effective Aug. 8, 2025
- CPCPLAB019 Thyroid Disease Testing, effective Aug. 8, 2025
- CPCPLAB029 Intracellular Micronutrient Analysis, effective Aug. 8, 2025
- CPCPLAB034 Salivary Hormone Testing, effective Aug. 8, 2025
- CPCPLAB038 Urinary Tumor Markers for Bladder Cancer, effective Aug. 8, 2025
- CPCPLAB043 Evaluation of Dry Eyes, effective Aug. 8, 2025
- CPCPLAB044 Lyme Disease Testing, effective Aug. 8, 2025
- CPCPLAB055 Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing, effective Aug. 8, 2025
- CPCPLAB058 Venous and Arterial Thrombosis Risk Testing, effective Aug. 8, 2025
- CPCPLAB059 Diagnosis of Vaginitis, Aug. 8, 2025
- CPCPLAB065 Human Immunodeficiency Virus, effective Aug. 8, 2025
- CPCPLAB068 Onychomycosis Testing, effective Aug. 8, 2025
- CPCPLAB070 Prescription Medication and Illicit Drug Testing, effective Aug. 8, 2025
- CPCPLAB071 Colorectal Cancer Screening, effective Aug. 8, 2025
- Clinical Laboratory Compensation Policy, effective Aug. 1, 2025
- Codes with No Other Standard BCBSMT Compensation Methodology Policy, effective June 1, 2025
- Dental with Medical Benefits Compensation Policy, effective May 9, 2025
- Drug Compensation Policy, effective June 1, 2025
- Drug Compensation Policy NDC Billing Frequently Asked Questions, effective June 1, 2025
- Drug Compensation Policy NDC Billing Guidelines, effective June 1, 2025
- Home Health Compensation Policy, effective May 9, 2025
- Hospice Compensation Policy, effective June 2, 2025
- Modifier Compensation and Reference Policy, effective Jan. 1, 2025
- Non-Physician Compensation Policy, effective May 9, 2025
- Professional Provider and Hospital Outpatient DX&L Compensation Policy, effective June 1, 2025
For more details, refer to the revised policies in Availity® Essentials through the Plan Documents Viewer application. You can access the application in Payer Spaces for Blue Cross and Blue Shield of Montana.
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
Coding and Compensation Policies are based on health care professionals’ and industry standard guidelines. The coding and compensation guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.
The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.