Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Laboratory)
Introduction Blue Cross and Blue Shield of Minnesota (Blue Cross) does not
allow providers to bill the health plan for laboratory services or
imaging studies that are not ordered by a physician or other
qualified practitioner because in addition to receiving lab or
radiology results, the patient also needs interpretation of the tests,
recommendations for future care, and a course of action that only a
physician or other qualified practitioner can deliver. In addition,
tests must be medically necessary in order to be eligible for
coverage. As a result, we will only issue payment for services that
are coordinated by a physician or other qualified practitioner. A
qualified practitioner is a practitioner recognized as an eligible
provider by Blue Cross and practices within the scope of his or her
licensure. Specific licensing questions should be directed to your
specialty’s licensing board.
Organ or Disease-
Oriented Panels
Laboratory and pathology procedures should be submitted using
the HCPCS level I or II code that best describes the service. CPT
codes 80047-89358 encompass level I codes for the majority of
laboratory and pathology procedures.
The services listed in the pathology and laboratory section of the
CPT manual may be provided by the pathologist or alternatively
by technologists who are under the supervision of the pathologist
or practitioner.
The guidelines outlined below should be adhered to when
submitting laboratory services to Blue Cross.
The tests listed under each panel (80047-80076) identify the
defined components of that panel, and all tests listed must be
performed in order to bill for that panel. Tests performed in
addition to those specifically indicated for a particular panel can be
billed separately in addition to the panel code.
Lab panels should be reported as 1 line item with 1 unit per panel.
Lyme Disease Titer Laboratory testing codes for Lyme disease titer are 86617 or
86618.
Office Visits A level-of-service office visit may be submitted in addition to
laboratory tests only when additional separately identifiable
services are provided. Obtaining a specimen for a streptococcus
test, for example, and relaying the results to the patient are
included in the reimbursement for the test itself and may not be
billed separately. A minimal level of service may be submitted if a
brief history and examination is performed in addition to the
laboratory test.
11-2
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/23/12)