Antibody Tests for Neurologic Diseases

Covered only when clinically indicated: antibody testing for specific paraneoplastic and non‑paraneoplastic neurologic disorders (e.g., Anti‑AChR, amphiphysin, CV2/CRMP5, Hu, Yo, Ri, Ma/TA, VGCC/VGKC, recoverin, GM1/GD1a/GQ1b/MOG, AQP4/NMO‑IgG, GAD, MUSK, etc.) is medically necessary only if the patient has compatible clinical features, the result will directly affect treatment, and after history, exam and conventional diagnostics a definitive diagnosis remains uncertain and a specific antibody is suspected; LEMS P/Q‑type VGCC testing is necessary when clinical/electrophysiology are inconclusive, serum AQP4 is necessary for optic neuritis/NMO vs MS evaluation, and CSF MOG antibody measurement is necessary for diagnosing MOG‑EM. Not covered/experimental: Anti‑HH3 and Ns6S for ALS, routine/screening antibody panels, auto‑antibody testing for childhood‑acquired demyelinating syndromes, routine anti‑neuronal testing for early childhood‑onset epilepsy without features of autoimmune encephalitis, and specified CPTs (e.g., 0431U, 86363 for the listed indications) are considered investigational and not covered.