MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

Outpatient molecular syndromic panels (>1 pathogen) are conditionally covered when testing is clinically indicated, results will impact management, testing follows intended-use/sample requirements, and documentation and regulatory requirements (CLIA/FDA/MolDX TA when applicable) are met. Expanded panels (≥6 pathogens) are restricted and only covered when targeted panels are insufficient and additional panel-specific criteria (respiratory, GI, UG/AG, ME, BSI, UTI) and specialist/clinical severity requirements are satisfied; repeat testing is limited (generally prohibited within 14 days except one allowed between 1–14 days if prior test was negative and high suspicion exists).

"Outpatient molecular syndromic panels (tests detecting >1 pathogen) are covered when all policy requirements are met; this policy does not address inpatient testing."

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