Reimbursement Policies

Updated Lab Benefit Management (LBM) Reimbursement Policies

EmblemHealth has updated the following reimbursement policies. See revision history for updates and effective dates. 

• Allergen Testing (LBM).
• Biomarker Testing for Autoimmune Rheumatic Disease (LBM).
• Cardiovascular Disease Risk Assessment (LBM).
• Colorectal Cancer Screening (LBM).
• Diagnosis of Vaginitis (LBM).
• Diagnostic Testing of Common Sexually Transmitted Infections (LBM).
• Epithelial Cell Cytology in Breast Cancer Risk Assessment (LBM).
• Evaluation of Dry Eyes Testing (LBM).
• Flow Cytometry (LBM).
• Folate Testing (LBM).
• Helicobacter Pylori Testing (LBM).
• Hepatitis Testing (LBM).
• Human Immunodeficiency Virus (HIV) (LBM).
• Lyme Disease Testing (LBM).
• Micronutrient Testing (LBM) (Previously titled Intracellular Micronutrient Analysis (LBM)).
• Onychomycosis Testing (LBM).
• Pancreatic Enzyme Testing for Acute Pancreatitis (LBM).
• Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing (LBM).
• Pediatric Preventive Screening (LBM).
• Prescription Medication and Illicit Drug Testing in the Outpatient Setting (LBM).
• Prostate Specific Antigen (PSA) Testing (LBM).
• Salivary Hormone Testing (LBM).
• Serum Tumor Markers for Malignancies (LBM).
• Thyroid Disease Testing (LBM).
• Urinary Tumor Markers for Bladder Cancer (LBM).
• Venous and Arterial Thrombosis Risk Testing (LBM).

Updated Reimbursement Policies: See revision history for updates and effective dates.

• Bundled Services.
• Coding Edits Policy.
• Hospital Readmissions.
• Modifier Reference Policy.
• National Drug Code (NDC) Requirements for Drug Claims.
• Preventive Care Services (Medicare).

Updated Payment Integrity Policy: See revision history for updates and effective dates.

• Device, Implant and Skin Substitutes Coding Guidelines (Facilities).

Reimbursement Policy Reminder: See article on Facility Transfer – Commercial effective July 15, 2026.