Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing

This policy covers multiplex gastrointestinal pathogen nucleic acid detection panel testing of five or fewer targets on stool specimens to identify bacterial, viral, and parasitic causes of gastroenteritis or infectious colitis. Coverage is limited to symptomatic patients when results will affect management—including immunocompromised individuals, critically ill or hospitalized patients, those with severe or persistent diarrhea, atypical presentations, or significant underlying GI disease—and requires tests validated for the intended population; panels >5 targets are generally not covered except for limited expanded (>6 target) panels that meet specific clinical criteria, testing must be on stool (not after recent laxative use or if diarrhea has resolved within 7 days), requisite documentation and coding/place-of-service requirements must be met, and standard-of-care methods may be preferred for many targets.

"Multiplex gastrointestinal pathogen nucleic acid detection panel testing of five or fewer targets for patients with symptoms of gastroenteritis or infectious colitis using stool samples"