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Complete Blood Count, Hemoglobin, and Hematocrit

Blue Cross & Blue Shield of Mississippi·MS·Medical Policy
Effective date
Jul 1, 2016
We identified it
Jun 20, 2026
Days to comply

Summary

BCBS Mississippi established a new medical policy defining when Complete Blood Count, Hemoglobin, and Hematocrit tests are considered medically necessary. The policy provides extensive coverage criteria for CBC/Hgb/Hct based on specific symptoms, conditions, and clinical indications across hematological disorders.

Action Required

Action needed
Immediately: Review current CBC, hemoglobin, and hematocrit ordering practices to ensure they align with the covered indications listed in policy L.2.04.420. Providers must document appropriate symptoms or conditions from the policy's extensive list when ordering these tests. Claims for CBC/Hgb/Hct tests without documented medical necessity per this policy will be denied.

Affected Billing Codes

B18.2
E83.110
F32.9
J01.00
J01.10
J01.90
J02.0
J02.9
J03.00
J03.90
J06.9
J10.1
J11.1
J15.9
J18.9
J20.9
J21.9
J32.9
K62.5
K80.20
L03.115
L03.116
L03.90
L70.0
N39.0
N93.8
N93.9
R00.2
R07.2
R10.2
R21
R59.9
Z79.899
Z94.0
Z94.4