Multiplex Pathogen Identification Panels for Infectious Disease - MEDICAID - VIRGINIA

Humana Medicaid (VA) covers NAATs for bacterial vaginitis in symptomatic women and covers expanded respiratory multiplex panels (6+ targets) for outpatient, immunocompromised or high-risk individuals when prior targeted (2-5 target) testing was negative and results will affect therapeutic management. The policy excludes certain NGS/metagenomic assays (eg, NeXGen Fungal/AFB [0531U], Karius [0152U], Johns Hopkins mNGS [0323U]), combination pathogen+antibiotic-resistance panels, and expanded vaginitis panels due to insufficient evidence. Documentation must show symptoms, prior targeted test results, treatment-impact rationale, and immunocompromised/high-risk status.

"Nucleic acid amplification tests (NAATs) for diagnosis of bacterial vaginitis (eg, BD MAX Vaginal Panel [81514], Aptima BV Assay [81513]) in women with symptoms of vaginitis (eg, abnormal discharge..."