CG-LAB-14 Respiratory Viral Panel Testing in the Outpatient Setting

This policy addresses outpatient respiratory viral panel (RVP) testing using multiplex nucleic acid assays. It is medically necessary only when a limited panel of 5 targets or fewer is used, the patient is at high risk for complications (e.g., immunocompromised such as transplant recipients), and the results will guide or change management; it is not covered for average-risk individuals, when these criteria are not met, or when large panels with 6 or more targets are used. Key limitations: outpatient setting only and coverage hinges on both patient risk status and clinical utility of results.

"Respiratory viral panel testing in the outpatient setting is consideredmedically necessarywhen all of the following criteria have been met:"

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