Lab: Special Histochemical Stains and Immunohistochemical Stains

Special histochemical and immunohistochemical stains are covered when medically necessary to render a complete and accurate diagnosis that is documented by the pathologist and used by the treating physician to guide management. Pathologists must review routine H&E slides before ordering additional stains except in recognized exceptions (e.g., renal, liver, neuromuscular biopsies, suspected infection in immunocompromised patients), and documentation in the surgical pathology report must specify blocks, markers, reasons, and results. Routine or standing orders to perform specific stains on all cases (e.g., Ki-67 or EGFR on every breast cancer), excessive non-actionable staining, chemosensitivity panels, and use of IHC solely to duplicate flow cytometry/cytogenetics are not covered.

"Special histochemical or immunohistochemical (IHC) stains are medically necessary when they are required to provide a complete and accurate diagnosis that will be communicated to and used by the tr..."