Polymerase Chain Reaction Respiratory Viral Panel Testing

This policy covers PCR-based respiratory viral panel testing (detection of viral RNA/DNA) for panels of five pathogens or fewer when clinically indicated to identify causative respiratory pathogens and guide treatment, infection control, or other management. Coverage is allowed for immunocompetent patients with suspected or atypical presentations, immunocompromised patients (including one pre‑transplant evaluation), critically ill or inpatient cases, and those with severe underlying respiratory disease, but is limited to tests validated for the intended population that include required pathogens, requires appropriate clinical documentation and billing with specified diagnosis/place-of-service codes, and excludes panels of more than five pathogens or testing unlikely to change management.

"Respiratory viral panel (RVP) testing for five pathogens or fewer when the member has a clinical indication for infectious disease testing and meets all specified criteria"