All PlansCoverageMedium impact
Lyme Disease Testing
Regence BlueShield·Infectious Disease, Family Medicine, Internal Medicine +2 more·Coding
Effective date
Jul 1, 2026
We identified it
Jul 7, 2026
Summary
Effective July 1, 2026, nine proprietary Lyme disease tests (from IGeneX, ID-FISH Technology, and Galaxy Diagnostics) are classified as investigational and non-covered. Billing teams must deny claims for these specific tests and inform providers that members may be billed directly, as these tests fall outside standard CDC-recommended two-step serologic testing protocols.
Action Required
By June 15, 2026: Billing team must update claim editing rules to deny all claims for the nine investigational Lyme disease tests listed in Policy LAB83: (A) Babesia ImmunoBlot IgG Test (IGeneX), (B) Babesia ImmunoBlot IgM Test (IGeneX), (C) Bartonella ImmunoBlot IgG Test (IGeneX), (D) Bartonella ImmunoBlot IgM Test (IGeneX), (E) iDart™ Lyme IgG ImmunoBlot Kit (ID-FISH), (F) iDart™ Lyme IgM ImmunoBlot Kit (ID-FISH), (G) Lyme Borrelia NanoTrap® Urine Antigen Test (Galaxy Diagnostics), (H) Lyme ImmunoBlot IgG (IGeneX), and (I) Lyme ImmunoBlot IgM (IGeneX). Configure billing system to automatically reject these tests with denial reason 'Investigational—Non-Covered Service.' Notify all in-network providers and laboratory vendors of the change. Create template letter to inform members they are financially responsible for these tests if ordered. Update prior authorization rules to prevent authorization requests for these tests. Route any claims received after July 1, 2026 to denial queue with investigational service code. Failure to implement will result in improper claim denials and member confusion regarding financial responsibility.