Respiratory Pathogen Panel Testing

Medicare Part B covers respiratory pathogen panel testing in the outpatient setting only when panels detect five or fewer respiratory pathogens, the site can provide timely result reporting, and the test result will inform clinical management to improve patient outcomes. Coverage requires documentation demonstrating analytical and clinical validity and clinical utility; LDTs may be covered if validation and utility are documented. Panels detecting more than five pathogens in the Part B outpatient setting are not considered medically reasonable and necessary.

"Respiratory pathogen panel testing is covered in the Part B outpatient setting when the panel contains five or fewer respiratory pathogens."

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