Testing for Select Genitourinary Conditions

This policy covers diagnostic testing for vaginitis and select genitourinary conditions, including point-of-care tests (vaginal pH, KOH/whiff, saline microscopy, sialidase/OSOM BVBlue), Gram stain (Nugent/Hay‑Ison) and targeted molecular tests (direct DNA probes, NAATs) to identify bacterial vaginosis, vulvovaginal candidiasis and related coinfections. Coverage is limited to symptomatic members aged ≥16; testing in asymptomatic individuals (including routine exams or pregnancy screening to prevent preterm birth), unspecified/multiplex amplified DNA probe panels and certain NAAT vaginitis panels are considered not medically necessary, and Trichomonas testing is not governed by this policy.

"Diagnostic testing to identify the etiology of signs and symptoms of vaginitis in members/enrollees aged ≥16 years."

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