Nucleaic Acid Pathogen Testing - (0530)

Cigna covers NAATs for specified STIs (chlamydia, gonorrhea, trichomonas, HSV1/2, high‑risk HPV), Gardnerella, Candida, and select multiplex respiratory (up to ~11 targets outpatient), GI (up to 11 targets) and CNS (12–25 targets) panels, but excludes mNGS, antibiotic‑resistance panels, NAAT quantification, low‑risk HPV, syphilis NAAT, skin/nail fungal and outpatient urinary‑tract NAATs, unspecified/high‑target multiplex codes, and use of NOS CPTs when specific codes exist. Reimbursement requires meeting the policy’s clinical criteria and covered ICD‑10 codes with documented signs/symptoms or high‑risk screening justification, use of specific CPT/HCPCS codes, CLIA validation when required, and adherence to frequency limits (e.g., respiratory panels ≤1 test per date of service and ≤12 tests per 12 rolling months).

"Nucleic acid pathogen testing for certain sexually transmitted infections is considered medically necessary for EITHER: (1) asymptomatic individual with any of the following: high-risk behavior (e."