Lab: Special Histochemical Stains and Immunohistochemical Stains
L36805
Special histochemical and immunohistochemical stains are medically necessary when ordered by a pathologist to complete an accurate diagnosis, when results are used by the treating physician, and when the pathology report documents the reason, blocks tested, markers, and results. Reflex pre-orders or routine universal staining prior to H&E review are not covered except for recognized exceptions (e.g., renal, liver, neuromuscular biopsies, certain infectious workups, and select sentinel node circumstances); select predictive markers (ER/PR/HER2 for breast and gastric adenocarcinoma and Ki-67 for a specific high-risk breast cancer scenario) and targeted uses in organ-specific contexts are covered, while nonactionable/excessive stains and chemosensitivity panels are not covered.
"A pathologist may perform additional special stains or IHC when medically necessary to produce a complete and accurate diagnosis, provided the results are communicated to and used by the treating p..."