Multiplex Pathogen Identification Panels for Infectious Disease - Medicare Advantage

This policy covers multiplex molecular and proteomic pathogen identification panels for infectious diseases — including respiratory pathogen panels, multiplex gastrointestinal pathogen panels, bloodstream infection, meningoencephalitis/CNS, urinary and urogenital/anogenital testing, and related molecular assays (e.g., select Zika PCR/ELISA tests). Coverage is determined by the applicable Medicare Administrative Contractor’s (MAC) LCD/LCA/NCD within its geographic jurisdiction and requires MolDX program–approved technical assessment where applicable; providers must follow the MAC/CMS guidance and member-specific coverage documents, and medical director review may influence determinations.

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