LCDActive
MolDX: Prometheus® IBD sgi Diagnostic® Policy
L37313
Effective: March 13, 2025
Updated: December 31, 2025
Policy Summary
The Prometheus IBD sgi Diagnostic test is non-covered and should not be billed for use in differentiating IBD vs non-IBD or Crohn's disease vs ulcerative colitis. The test comprises 17 reported biomarkers (nine serologic markers, four SNPs, five inflammatory markers) and a proprietary algorithmic IBD score, but neither the panel nor algorithmic interpretation is covered under this policy.
Coverage Criteria Preview
Key requirements from the full policy
"The Prometheus IBD sgi Diagnostic test (including its 17-biomarker panel and proprietary Smart Diagnostic Algorithm) is non-covered for use to differentiate inflammatory bowel disease (IBD) vs non-..."
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