Special Histochemical Stains and Immunohistochemical Stains

Special histochemical and immunohistochemical stains are covered when medically necessary to achieve a complete, accurate diagnosis that is documented by the pathologist and used by the treating clinician; the pathology report must specify blocks, markers, methods, reasons, and results. Blanket reflex/pre-orders or routine, non-actionable staining (including chemosensitivity panels and routine Ki-67 in breast cancer except a specified abemaciclib-related indication) are not reasonable or covered; exceptions to pre-ordering exist for specified biopsy types and clinical scenarios and must be documented.

"Special histochemical and immunohistochemical (IHC) stains are medically necessary when performed to provide a complete and accurate diagnosis that is communicated to and used by the treating physi..."

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