Respiratory Pathogen Panel Testing

Medicare Part B outpatient coverage is allowed for respiratory pathogen panel tests that detect five or fewer respiratory pathogens when performed in an outpatient setting that can deliver timely results and when the results will inform clinical management to improve patient outcomes. Panels detecting more than five pathogens in the Part B outpatient setting are not covered; coverage for tests (including LDTs) requires documentation of analytical and clinical validity and clinical utility and must comply with CMS medical necessity and payment rules.

"Respiratory pathogen panel testing performed in the Part B outpatient setting is covered when the panel detects ≤5 respiratory pathogens."

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