LAB.00050 Metagenomic Sequencing for Infectious Disease in the Outpatient Setting

• Service: Clinical metagenomic next-generation sequencing (mNGS) tests to detect infectious pathogens in the outpatient setting. • Coverage: Not covered—Anthem considers outpatient mNGS investigational and not medically necessary for all indications. • Limitations: Applies to all outpatient scenarios and specimen types with no exceptions (e.g., may be billed under CPT/HCPCS 87999); inpatient coverage is not addressed by this policy.

"Metagenomic sequencing for infectious diseases in the outpatient setting is consideredinvestigational and not medically necessaryfor all indications."

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