Anthem Reimbursement Policy Update for Sexually Transmitted Infection Testing

September 21, 2021

Anthem Blue Cross and Blue Shield has announced for several states a new reimbursement policy update for Sexually Transmitted Infection Testing (STI) beginning with dates of service on or after December 1, 2021.   Anthem considers STI testing, CPT® codes 87491, 87591, and 87661, to be part of a laboratory panel grouping unless provider, state, or federal contracts and/or requirements indicate otherwise. When the Plan receives a claim with two or more single test laboratory procedure codes reported, the Plan will bundle those two or more single tests into the comprehensive laboratory procedure code 87801. The Plan will reimburse the more comprehensive, multiple organism CPT code 87801 when two or more single tests are billed separately by the same provider on the same date of service.  Regardless of the number of units billed, reimbursement will be based on a single unit of the CPT code 87801. 

Note: The provider is required to bill for the applicable single STI CPT codes, as rendered. The comprehensive CPT code will be reimbursed as indicated above. Modifiers will not override this new policy.

Code Description Comments
87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique 87591   
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  
87801 Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms, amplified probe(s) technique Requires reporting 1 unit when any two or more of codes 87491, 87591, or 87661 is reported

Currently, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio and Wisconsin have approved this policy. California and Virginia do not have this policy updated as of yet. 

For more information and to view this policy online, click here

APS looks to provide ongoing support to our clients to help identify new carrier policies.  We will continue to monitor this topic closely and provide updates when they become available.