MolDX: Prometheus IBD sgi Diagnostic® Policy

This policy establishes non-coverage for the Prometheus IBD sgi Diagnostic® test; it is not covered to differentiate IBD vs non-IBD or Crohn's disease vs Ulcerative Colitis. The non-coverage applies to the entire panel of 17 reported biomarkers (serologic, genetic, inflammatory) and the proprietary algorithmic interpretation, and therefore results from this test are not reimbursable under this policy.

"The Prometheus IBD sgi Diagnostic® test is non-covered for use in differentiating inflammatory bowel disease (IBD) versus non-IBD."

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