Laboratory Management Policies

Efficient, Cost-Effective Care

The reimbursement policies listed below outline how lab and diagnostic testing is reviewed for coverage and payment. The effective date for each policy is next to the policy name.

Laboratory Procedures Reimbursement Policy

A medical professional sits in front of her laptop computer taking notes in a notebook.

Current Policies

Active Laboratory Reimbursement Policies

The policies listed below are currently active. The effective date for each policy is next to the policy name.

View Active Policies

Policy Name	Posted Date	Effective Date
Allergen Testing - G2031	3/10/26	5/10/26
B-Hemolytic Streptococcus Testing (BlueCare) - G2159	4/22/25	6/25/25
Biochemical Markers of Alzheimer Disease and Dementia - G2048	2/25/25	4/25/25
Biomarker Testing for Autoimmune Rheumatic Disease (BlueCare, Medicare Advantage, DSNP) – G2022	3/10/26	5/10/26
Biomarkers for Myocardial Infarction and Chronic Heart Failure – G2150	2/25/25	4/25/25
Bone Turnover Markers Testing – G2051	2/25/25	4/25/25
Cardiovascular Disease Risk Assessment (Commercial, BlueCare, Medicare Advantage, DSNP) - G2050	2/25/25	4/25/25
Celiac Disease Testing – G2043	2/25/25	4/25/25
Cervical Cancer Screening (Commercial, BlueCare) – G2002	2/25/25	4/25/25
Coronavirus Testing in the Outpatient Setting - G2174	1/15/26	3/15/26
Diabetes Mellitus Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2006	1/15/26	3/15/26
Diagnosis of Idiopathic Environmental Intolerance – G2056	1/15/26	3/15/26
Diagnosis of Vaginitis (Commercial, BlueCare, Medicare Advantage, DSNP) – M2057	3/10/26	5/10/26
Diagnostic Testing of Common Sexually Transmitted Infections – G2157	2/25/25	4/25/25
Diagnostic Testing of Influenza – G2119	2/25/25	4/25/25
Diagnostic Testing of Iron Homeostasis and Metabolism – G2011	1/15/26	3/15/26
Epithelial Cell Cytology in Breast Cancer Risk Assessment – G2059	2/25/25	4/25/25
Evaluation of Dry Eyes – G2138	3/10/26	5/10/26
Fecal Analysis in the Diagnosis of Intestinal and Fecal Microbiota Transplant Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2060	2/25/25	4/25/25
Fecal Calprotectin Testing in Adults (Commercial, Medicare Advantage, BlueCare, DSNP; not adopted for FEP) – G2061	2/25/25	4/25/25
Flow Cytometry – F2019	3/10/26	5/10/26
Folate Testing – G2154	2/25/25	4/25/25
Gamma-glutamyl Transferase Testing in Adults – G2173	2/25/25	4/25/25
General Inflammation Testing – G2155	2/25/25	4/25/25
Helicobacter Pylori Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2044	3/10/26	5/10/26
Hepatitis Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2036	2/25/25	4/25/25
Human Immunodeficiency Virus (HIV) – M2116	3/10/26	5/10/26
Identification of Microorganisms Using Nucleic Acid Probes – M2097	2/25/25	4/25/25
Immune Cell Function Assay (Commercial, Medicare Advantage, DSNP) – G2098	1/15/26	3/15/26
Immunohistochemistry – P2018	1/15/26	3/15/26
Immunopharmacologic Monitoring of Therapeutic Serum Antibodies (Commercial, BlueCare, Medicare Advantage, DSNP) – G2105	2/25/25	4/25/25
In Vitro Chemoresistance and Chemosensitivity Assays (Commercial, BlueCare, Medicare Advantage, DSNP) – G2100	2/25/25	4/25/25
Intracellular Micronutrient Analysis – G2099	3/10/26	5/10/26
Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease (Commercial, BlueCare, Medicare Advantage, DSNP) – G2121	2/25/25	4/25/25
Lyme Disease Testing – G2143	3/10/26	5/10/26
Metabolites Markers of Thiopurines Testing – G2115	2/25/25	4/25/25
Nerve Fiber Density Testing – M2112	2/25/25	4/25/25
Onychomycosis Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – M2172	3/10/26	5/10/26
Oral Cancer Screening and Testing (Commercial, Bluecare, Medicare Advantage, DSNP) – G2113	2/25/25	4/25/25
Pancreatic Enzyme Testing for Acute Pancreatitis – G2153	2/25/25	4/25/25
Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing – G2164	3/10/26	5/10/26
Pathogen Panel Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2149	2/25/25	4/25/25
Pediatric Preventive Screening – G2042	3/10/26	5/10/26
Prenatal Screening (Nongenetic) – G2035	3/10/26	5/10/26
Prescription Medication and Illicit Drug Testing in the Outpatient Setting (BlueCare) – T2015	3/10/26	5/10/26
Prostate Biopsy Specimen Analysis – G2007	2/25/25	4/25/25
Salivary Hormone Testing – G2120	3/10/26	5/10/26
Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Disease – G2123	2/25/25	4/25/25
Serum Testing for Evidence of Mild Traumatic Brain Injury – G2151	2/25/25	4/25/25
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease (Commercial, BlueCare, Medicare Advantage, DSNP) – G2110	2/25/25	4/25/25
Serum Tumor Markers for Malignancies (Commercial, BlueCare) – G2124	4/22/25	6/25/25
Testing for Alpha-1 Antitrypsin Deficiency – M2068	2/25/25	4/25/25
Testing for Diagnosis of Active or Latent Tuberculosis (BlueCare) - G2063	4/22/25	6/25/25
Testing for Vector-borne Infections – G2158	2/25/25	4/25/25
Testing of Homocysteine Metabolism – Related Conditions – M2141	1/15/26	3/15/26
Testosterone – G2013	1/15/26	3/15/26
Therapeutic Drug Monitoring for 5-Fluorouracil – M2067	1/15/26	3/15/26
Thyroid Disease Testing (Commercial, Medicare Advantage, DSNP) – G2045	3/10/26	5/10/26
Urinary Tumor Markers for Bladder Cancer (BlueCare) – G2125	3/10/26	5/10/26
Urine Culture Testing for Bacteria – G2156	2/25/25	4/25/25
Venous and Arterial Thrombosis Risk Testing – M2041	3/10/26	5/10/26
Vitamin B12 and Methylmalonic Acid Testing – G2014	1/15/26	3/15/26
Vitamin D Testing – G2005	1/15/26	3/15/26

Loading component...

Upcoming Policies

Pending Laboratory Reimbursement Policies

The policies listed below are not active yet. The effective date for each policy is next to the policy name.

View Pending Policies

Policy Name	Posted Date	Effective Date
Biomarkers for Myocardial Infarction and Chronic Heart Failure – G2150	5/5/26	7/10/26
Cardiovascular Disease Risk Assessment (Commercial, BlueCare, Medicare Advantage, DSNP) - G2050	5/5/26	7/10/26
Coronavirus Testing in the Outpatient Setting - G2174	5/5/26	7/10/26
Folate Testing – G2154	5/5/26	7/10/26
General Inflammation Testing – G2155	5/5/26	7/10/26
Hepatitis Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2036	5/5/26	7/10/26
Identification of Microorganisms Using Nucleic Acid Probes – M2097	5/5/26	7/10/26
Pancreatic Enzyme Testing for Acute Pancreatitis (Commercial, Bluecare, Medicare Advantage, DSNP) – G2153	5/5/26	7/10/26
Pathogen Panel Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2149	5/5/26	7/10/26
Serum Testing for Evidence of Mild Traumatic Brain Injury – G2151	5/5/26	7/10/26
Serum Tumor Markers for Malignancies (BlueCare) – G2124	5/5/26	7/10/26

Archived Policies

Archived Laboratory Reimbursement Policies

The policies listed below are currently archived. They’re for historical reference only.

View Archived Policies

Policy Name	Effective Date	End Date
Allergen Testing	9/1/23	11/1/23
Allergen Testing – G2031	11/1/23	5/10/26
B-Hemolytic Streptococcus Testing	9/1/23	11/1/23
B-Hemolytic Streptococcus Testing - G2159	11/1/23	4/1/24
B-Hemolytic Streptococcus Testing - G2159	4/1/24	4/25/25
Biochemical Markers of Alzheimer Disease and Dementia	9/1/23	11/1/23
Biochemical Markers of Alzheimer Disease and Dementia - G2048	11/1/23	4/1/24
Biochemical Markers of Alzheimer Disease and Dementia - G2048	4/1/24	4/25/25
Biomarker Testing for Autoimmune Rheumatic Disease - G2022	11/1/23	5/10/26
Biomarker Testing for Autoimmune Rheumatoid Arthritis (FEP only) - G2022	2/3/25	5/10/26
Biomarkers for Myocardial Infarction and Chronic Heart Failure - G2150	11/1/23	4/1/24
Biomarkers for Myocardial Infarction and Chronic Heart Failure - G2150	4/1/24	4/25/25
Bone Turnover Markers Testing	9/1/23	11/1/23
Bone Turnover Markers Testing - G2051	11/1/23	4/1/24
Bone Turnover Markers Testing - G2051	4/1/24	4/25/25
Cardiac Biomarkers for Myocardial Infarction	9/1/23	11/1/23
Cardiovascular Disease Risk Assessment	9/1/23	11/1/23
Cardiovascular Disease Risk Assesment - G2050	11/1/23	4/25/25
Celiac Disease Testing	9/1/23	11/1/23
Celiac Disease Testing - G2043	11/1/23	4/1/24
Celiac Disease Testing - G2043	4/1/24	4/25/25
Cervical Cancer Screening	9/1/23	11/1/23
Cervical Cancer Screening - G2002	11/1/23	4/1/24
Cervical Cancer Screening - G2002	4/1/24	4/25/25
Coronavirus Testing in the Outpatient Setting	9/1/23	11/1/23
Coronavirus Testing in the Outpatient Setting - G2174	11/1/23	3/15/26
Diabetes Mellitus Testing - G2006	11/1/23	3/15/26
Diagnosis of Idiopathic Environmental Intolerance	9/1/23	11/1/23
Diagnosis of Idiopathic Environmental Intolerance - G2056	11/1/23	3/15/26
Diagnosis of Vaginitis (FEP only) - M2057	2/3/25	5/10/26
Diagnosis of Vaginitis including Multi-target PCR Testing	9/1/23	11/1/23
Diagnosis of Vaginitis including Multi-target PCR Testing - M2057	11/1/23	5/10/26
Diagnostic Testing of Common Sexually Transmitted Infections	9/1/23	11/1/23
Diagnostic Testing of Common Sexually Transmitted Infections - G2157	11/1/23	4/1/24
Diagnostic Testing of Common Sexually Transmitted Infections - G2157	4/1/24	4/25/25
Diagnostic Testing of Influenza	9/1/23	11/1/23
Diagnostic Testing of Influenza - G2119	11/1/23	4/1/24
Diagnostic Testing of Influenza - G2119	4/1/24	4/25/25
Diagnostic Testing of Iron Homeostasis Metabolism	9/1/23	11/1/23
Diagnostic Testing of Iron Homeostasis Metabolism - G2011	11/1/23	3/15/26
Epithelial Cell Cytology in Breast Cancer Risk Assessment	9/1/23	11/1/23
Epithelial Cell Cytology in Breast Cancer Risk Assessment - G2059	11/1/23	4/1/24
Epithelial Cell Cytology in Breast Cancer Risk Assessment - G2059	4/1/24	4/25/25
Erectile Dysfunction	9/1/23	11/1/23
Evaluation of Dry Eyes Testing	9/1/23	11/1/23
Evaluation of Dry Eyes Testing - G2138	11/1/23	5/10/26
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing	9/1/23	11/1/23
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing - G2060	11/1/23	4/1/24
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing - G2060	4/1/24	4/25/25
Fecal Calprotectin Testing in Adults	9/1/23	11/1/23
Fecal Calprotectin Testing - G2061	11/1/23	4/1/24
Fecal Calprotectin Testing - G2061	4/1/24	4/25/25
Flow Cytometry	9/1/23	11/1/23
Flow Cytometry - F2019	11/1/23	4/25/25
Flow Cytometry – F2019	4/25/25	5/10/26
Folate Testing	9/1/23	11/1/23
Folate Testing - G2154	11/1/23	4/25/25
Gamma-Glutamyl Transferase	9/1/23	11/1/23
Gamma-Glutamyl Transferase - G2173	11/1/23	4/25/25
General Inflammation Testing	9/1/23	11/1/23
General Inflammation Testing - G2155	11/1/23	4/25/25
Genetic Testing for Adolescent Idiopathic Scoliosis	9/1/23	11/1/23
Helicobacter Pylori Testing	9/1/23	11/1/23
Helicobacter Pylori Testing - G2044	11/1/23	5/10/26
Helicobacter Pylori Testing (FEP only) - G2044	2/3/25	5/10/26
Hepatitis C	9/1/23	11/1/23
Hepatitis C Testing - G2036	11/1/23	4/1/24
Hepatitis Testing - G2036	4/1/24	4/25/25
HIV Genotyping and Phenotyping	9/1/23	11/1/23
HIV Genotyping and Phenotyping - M2093	11/1/23	Q1 2023
Human Immunodeficiency Virus (HIV) - M2116	11/1/23	5/10/26
Identification of Microorganisms Using Nucleic Acid Probes	9/1/23	11/1/23
Identification of Microorganisms Using Nucleic Acid Probes - M2097	11/1/23	4/25/25
Immune Cell Function Assay	9/1/23	11/1/23
Immune Cell Function Assay - G2098	11/1/23	4/1/24
Immune Cell Function Assay - G2098	4/1/24	3/15/26
Immunohistochemistry	9/1/23	11/1/23
Immunohistochemistry - P2018	11/1/23	3/15/26
Immunopharmacologic Monitoring of Therapeutic Serum Antibodies	9/1/23	11/1/23
Immunopharmacologic Monitoring of Therapeutic Serum Antibodies - G2105	11/1/23	4/1/24
Immunopharmacologic Monitoring of Therapeutic Serum Antibodies - G2105	4/1/24	4/25/25
In Vitro Chemoresistance and Chemosensitivity Assays	9/1/23	11/1/23
In Vitro Chemoresistance and Chemosensitivity Assays - G2100	11/1/23	4/1/24
In Vitro Chemoresistance and Chemosensitivity Assays - G2100	4/1/24	4/25/25
Intracellular Micronutrient Analysis	9/1/23	11/1/23
Intracellular Micronutrient Analysis - G2099	11/1/23	5/10/26
Laboratory Procedures Reimbursement Policy	11/1/23	3/15/26
Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease	9/1/23	11/1/23
Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease - G2121	11/1/23	4/1/24
Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease - G2121	4/1/24	4/25/25
Lyme Disease	9/1/23	11/1/23
Lyme Disease Testing - G2143	11/1/23	5/10/26
Measurement of Thromboxane Metabolites for ASA Resistance	9/1/23	11/1/23
Measurement of Thromboxane Metabolites for ASA Resistance - G2107	11/1/23	4/1/24
Measurement of Thromboxane Metabolites for ASA Resistance - G2107	4/1/24	Q3 2024
Metabolite Markers of Thiopurines Testing	9/1/23	11/1/23
Metabolite Markers for Thiopurines Testing - G2115	11/1/23	4/1/24
Metabolite Markers for Thiopurines Testing - G2115	4/1/24	4/25/25
Nerve Fiber Density Testing	9/1/23	11/1/23
Nerve Fiber Density Testing - M2112	11/1/23	4/1/24
Nerve Fiber Density Testing - M2112	4/1/24	4/25/25
Onychomycosis Testing	9/1/23	11/1/23
Onychomycosis Testing - M2172	11/1/23	5/10/26
Onychomycosis Testing (FEP only) - M2172	2/3/25	5/10/26
Oral Cancer Screening and Testing - G2113	11/1/23	4/25/25
Oral Screening Lesion Identification Systems and Genetic Screening	9/1/23	11/1/23
Pancreatic Enzyme Testing for Acute Pancreatitis	9/1/23	11/1/23
Pancreatic Enzyme Testing for Acute Pancreatitis - G2153	11/1/23	4/25/25
Parathyroid Hormone Phosphorus Calcium and Magnesium Testing	9/1/23	11/1/23
Parathyroid Hormone Phosphorus Calcium and Magnesium Testing - G2164	11/1/23	5/10/26
Pathogen Panel Testing	9/1/23	11/1/23
Pathogen Panel Testing - G2149	11/1/23	4/25/25
Pediatric Preventive Screening	9/1/23	11/1/23
Pediatric Preventive Screening - G2042	11/1/23	5/10/26
Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection	9/1/23	3/10/26
Prenatal Screening-Nongenetic	9/1/23	11/1/23
Prenatal Screening-Nongenetic - G2035	11/1/23	4/25/25
Prenatal Testing (Nongenetic) – G2035	4/25/25	5/10/26
Prescription Medication and Illicit Drug Testing in Outpatient Setting	9/1/23	11/1/23
Prescription Meds and Illicit Drug Testing in the Outpatient Setting - T2015	11/1/23	5/10/26
Prescription Medication and Illicit Drug Testing in the Outpatient Setting (Commercial only) - T2015	2/3/25	5/10/26
Prostate Biopsies	9/1/23	11/1/23
Prostate Biopsies - G2007	11/1/23	4/1/24
Prostate Biopsy Specimen Analysis - G2007	4/1/24	4/25/25
Salivary Hormone Testing	9/1/23	11/1/23
Salivary Hormone Testing - G2120	11/1/23	5/10/26
Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases	9/1/23	11/1/23
Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases - G2123	11/1/23	4/1/24
Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases - G2123	4/1/24	4/25/25
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease	9/1/23	11/1/23
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease	11/1/23	4/1/24
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease - G2110	4/1/24	4/25/25
Serum Tumor Markers for Malignancies	9/1/23	11/1/23
Serum Tumor Markers for Malignancies - G2124	11/1/23	2/3/25
Serum Tumor Markers for Malignancies – G2124	2/3/25	6/25/25
Serum Tumor Markers for Malignancies (FEP only) - G2124	2/3/25	4/25/25
ST2 Assay for Chronic Heart Failure	9/1/23	11/1/23
Testing For Alpha-1 Antitrypsin Deficiency	9/1/23	11/1/23
Testing For Alpha-1 Antitrypsin Deficiency - M2068	11/1/23	4/25/25
Testing for Diagnosis of Active or Latent Tuberculosis	9/1/23	11/1/23
Testing for Diagnosis of Active or Latent Tuberculosis - G2063	11/1/23	4/1/24
Testing for Diagnosis of Active or Latent Tuberculosis - G2063	4/1/24	4/25/25
Testing for Vector-borne Infections - G2158	11/1/23	4/25/25
Testosterone Testing	9/1/23	11/1/23
Testosterone Testing - G2013	11/1/23	3/15/26
Thyroid Disease Testing	9/1/23	11/1/23
Thyroid Disease Testing - G2045	11/1/23	4/25/25
Thyroid Disease Testing (Commercial, MA, D-SNP) – G2045	4/25/25	5/10/26
Thyroid Disease Testing (FEP) – G2045	4/25/25	5/10/26
Urinary Tumor Markers for Bladder Cancer	9/1/23	11/1/23
Urinary Tumor Markers for Bladder Cancer - G2125	11/1/23	2/3/25
Urinary Tumor Markers for Bladder Cancer - G2125	2/3/25	5/10/26
Urine Culture Testing for Bacteria	9/1/23	11/1/23
Urine Culture Testing for Bacteria - G2156	11/1/23	4/25/25
Venous and Arterial Thrombosis Risk Testing	9/1/23	11/1/23
Venous and Arterial Thrombosis Risk Testing - M2041	11/1/23	4/25/25
Venous and Arterial Thrombosis Risk Testing – M2041	4/25/25	5/10/26
Vetra DA Blood Test for Rheumatoid Arthritis	9/1/23	11/1/23
Vitamin B12 Methylmalonic Acid Testing	9/1/23	11/1/23
Vitamin B12 Methylmalonic Acid Testing - G2014	11/1/23	3/15/26
Vitamin D Testing	9/1/23	11/1/23
Vitamin D Testing - G2005	11/1/23	3/15/26
Zika Virus Risk Assessment	9/1/23	11/1/23