Blue Cross Blue Shield of Michigan has partnered with Avalon Healthcare Solutions for Laboratory Benefits Management (LBM). The laboratory testing policies are accessible through the links below. These policies have been modified for Blue Cross Blue Shield of Michigan’s various products to align with government program policies, rules, and/or state and federal contracts, but note that in case of conflict, the government program policies, rules, and/or state and federal contracts will take precedence. These policies are not applicable to Blue Care Network of Michigan. 

DISCLAIMER: Application of coverage criteria is dependent upon an individual’s benefit coverage at the time of the request. If there is a conflict between this Policy and any relevant, applicable government policy [e.g., Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs) for Medicare] for a particular member, then the government policy will be used to make the determination. For the most up-to-date Medicare policies and coverage, please visit their search website https://www.cms.gov/medicare-coverage-database/search.aspx or the manual website.

Procedure codes with lab policy numbers and names This chart serves as a cross reference of the lab policy(s) affiliated to each procedure code for Blue Cross Blue Shield of Michigan commercial members. Please reference the actual policies for up-to-date information.