Update: Reimbursement for Multiple Individual Sexually Transmitted Infection Labs

Update February 6, 2025: Blue Cross and Blue Shield of North Carolina (Blue Cross NC) recently posted a communication regarding reimbursement for multiple individual labs using the most comprehensive procedure code. See below for the original announcement.

After further consideration, Blue Cross NC has updated editing to pause the bundling of Sexually Transmitted Infection (STI) testing codes. Any individual STI tests bundled to 87801 prior to the edit being paused will be reimbursed according to the original individual STI codes (87491, 87591, 87661) filed. Claims with date of service between January 1, 2024 – January 29, 2025, are potentially impacted.

There is no action providers need to take at this time, and providers should not resubmit claims. Any impacted claims will be adjusted by Blue Cross NC for reprocessing. We will work diligently to ensure claims are reprocessed in a timely manner.

Please note, this decision does not affect any other bundling guidelines of Blue Cross NC or change the requirement to file the most appropriate code to represent services provided. Blue Cross NC’s bundling policy, available here, remains the same.

This update applies to Commercial, Inter-Plan Program (IPP) Host, State Health Plan, Medicare Advantage, and Federal Employee Program (FEP). This does not apply to IPP Home.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) reimburses codes for multiple individual labs using the most comprehensive procedure code.

As a reminder, our bundling policy states: 

When all components are performed on the same date of service and are billed together, services are recoded into the more comprehensive procedure. 
 
Please see the example 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, more appropriate and comprehensive multiple organism code:

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

Blue Cross NC 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. 

This stance of recoding and/or reimbursing to the most comprehensive code applies to Commercial, Inter-Plan Program (IPP) Host, State Health Plan, Medicare Advantage, and Federal Employee Program (FEP). This does not apply to IPP Home.