Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

Multiplex GPP tests for acute gastroenteritis are covered when billed in POS 20, 21, 22, 23, or 81, and for pre-transplant immunocompromised evaluations billed in POS 81. Outside those locations, coverage requires ordering by a diagnosing/treating specialist (Infectious Diseases, Gastroenterology, Oncology, or Transplant) with documented specialist communication; a documented geographic access exception may apply in limited situations. Claims must include a valid ICD-10-CM diagnosis code, referring/ordering physician name and NPI where required, and medical-record documentation supporting medical necessity; NCCI and OPPS edits may affect payment.

"Multiplex GPP tests for diagnosis of acute gastroenteritis (AGE) are covered when billed in POS 20, 21, 22, 23, or 81."

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