MolDX: Prometheus® IBD sgi Diagnostic® Policy

This policy (L37260) explicitly designates the Prometheus IBD sgi Diagnostic test as non-covered for its intended uses, including aiding differentiation of IBD vs non-IBD and distinguishing Crohn's disease from Ulcerative Colitis. The test comprises 17 biomarkers (9 serologic markers, 4 genetic SNPs, 5 inflammatory markers) and a proprietary algorithmic IBD score, but reporting of individual biomarkers or the algorithmic interpretation does not alter the non-coverage determination.

"The Prometheus IBD sgi Diagnostic test is non-covered for use in differentiating inflammatory bowel disease (IBD) vs non-IBD and for differentiating Crohn's disease (CD) vs Ulcerative Colitis (UC)."

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