June 23, 2026
Reimbursement policies, formerly known as coding and compensation policies, describe payment rules and methodologies for Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System and ICD-10-CM 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 policies were updated:
- Durable Medical Equipment, Oxygen, Prosthetic/Orthotic and Supplies Reimbursement Policy, effective June 1, 2026
- Outpatient Facility Service(s) Overlapping During an Inpatient Stay, effective June 8, 2026
- RPLAB001 Flow Cytometry, effective Sept. 4, 2026
- RPLAB006 Prostate Specific Antigen Testing, effective Sept. 4, 2026
- RPLAB011 Biomarker Testing for Autoimmune Rheumatic Disease, effective Sept. 4, 2026
- RPLAB013 Allergen Testing, effective Sept. 4, 2026
- RPLAB015 Hepatitis Testing, effective Sept. 4, 2026
- RPLAB016 Pediatric Preventive Screening, effective Sept. 4, 2026
- RPLAB018 Helicobacter pylori Testing, effective Sept. 4, 2026
- RPLAB019 Thyroid Disease Testing, effective Sept. 4, 2026
- RPLAB020 Cardiovascular Disease Risk Assessment, effective Sept. 4, 2026
- RPLAB024 Epithelial Cell Cytology in Breast Cancer Risk Assessment, effective Sept. 4, 2026
- RPLAB029 Micronutrient Testing, effective Sept. 4, 2026
- RPLAB034 Salivary Hormone Testing, effective Sept. 4, 2026
- RPLAB037 Serum Tumor Markers for Malignancies, effective Sept. 4, 2026
- RPLAB038 Urinary Tumor Markers for Bladder Cancer, effective Sept. 4, 2026
- RPLAB043 Evaluation of Dry Eyes, effective Sept. 4, 2026
- RPLAB044 Lyme Disease Testing, effective Sept. 4, 2026
- RPLAB047 Pancreatic Enzyme Testing for Acute Pancreatitis, effective Sept. 4, 2026
- RPLAB048 Folate Testing, effective Sept. 4, 2026
- RPLAB051 Diagnostic Testing of Common Sexually Transmitted Infections, effective Sept. 4, 2026
- RPLAB055 Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing, effective Sept. 4, 2026
- RPLAB058 Venous and Arterial Thrombosis Risk Testing, effective Sept. 4, 2026
- RPLAB059 Diagnosis of Vaginitis, effective Sept. 4, 2026
- RPLAB065 Human Immunodeficiency Virus, effective Sept. 4, 2026
- RPLAB068 Onychomycosis Testing, effective Sept. 4, 2026
- RPLAB070 Prescription Medication and Illicit Drug Testing, effective Sept. 4, 2026
- RPLAB071 Colorectal Cancer Screening, effective Sept. 4, 2026
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 2025 American Medical Association. CPT is a registered trademark of the AMA.
Reimbursement Policies (formerly known as Coding and Compensation Policies) are based on health care professionals’ and industry standard guidelines. The reimbursement 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.