Rheumatoid Arthritis: Biologic Markers and Pharmacologic Assessment - Medicare Advantage

Covers molecular and biomarker testing to assess rheumatoid arthritis and guide therapy, including a 12‑biomarker immunoassay reported as a disease activity score (CPT 81490), PrismRA, NGS and multi‑gene MolDX panels, HLA locus testing, and serologic markers such as anti‑CarP, RF and ACPA. Applies to patients with rheumatoid arthritis submitting Medicare claims, but coverage, frequency, prior‑authorization, and exclusion specifics are determined by the referenced CMS LCDs/MolDX billing and coding articles and may be jurisdiction‑specific.

"Refer to CMS Medicare Coverage Database for the most current applicable CMS National Coverage Determination (NCD)/Local Coverage Determination (LCD)/Local Coverage Article (LCA)."

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