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Reimbursement Policies

11/17/2025

EmblemHealth and ConnectiCare are adding one new Lab Benefit Management (LBM) Reimbursement Policy: Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases (LBM).

The following reimbursement policies have been updated. If the policy name does not have a company name shown, the policy applies to both EmblemHealth and ConnectiCare. See their revision histories for effective dates and applicable changes:

  • Ambulatory Surgical Groupers. 
  • Beta-Hemolytic Streptococcus Testing (LBM).
  • Biochemical Markers of Alzheimer Disease and Dementia (LBM).
  • Bone Turnover Markers Testing (LBM).
  • Bundled Services. 
  • Celiac Disease Testing (LBM).
  • Cervical Cancer Screening (LBM).
  • Diabetes Mellitus Testing (LBM).
  • Diagnosis of Vaginitis (LBM).
  • Diagnostic Testing of Common Sexually Transmitted Infections (LBM).
  • Diagnostic Testing of Influenza (LBM).
  • DME Rental vs. Purchase. 
  • Epithelial Cell Cytology in Breast Cancer Risk Assessment (LBM).
  • Evaluation and Management (E&M) Services. 
  • Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing (LBM).
  • Fecal Calprotectin Testing in Adults No CPT code changes (LBM).
  • Gamma-glutamyl Transferase Testing in Adults (LBM).
  • Human Immunodeficiency Virus (HIV) (LBM).
  • Immunopharmacologic Monitoring of Therapeutic Serum Antibodies (LBM).
  • In Vitro Chemoresistance and Chemosensitivity Assays (LBM).
  • Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease (LBM).
  • Laboratory/Venipuncture. 
  • Metabolite Markers of Thiopurines Testing (LBM).
  • Oral Cancer Screening and Testing (LBM).
  • Pathogen Panel Testing (LBM).
  • Prenatal Screening (Nongenetic) (LBM).
  • Preventive Care Services (Commercial).
  • Preventive Care Services (Medicare).
  • Prostate Biopsy Specimen Analysis (LBM).
  • Radiopharmaceuticals and Contrast Media. 
  • Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease (LBM).
  • Testing for Alpha-1 Antitrypsin Deficiency (LBM).
  • Testing for Diagnosis of Active or Latent Tuberculosis (LBM).
  • Testing for Vector-Borne Infections (LBM).
  • Urine Culture Testing for Bacteria (LBM).

JP70544 11/2025

Provider Update