MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

Outpatient molecular syndromic panels (>1 pathogen) are covered when testing is medically indicated, performed according to intended use/validated sample types, and results will impact management as supported by peer-reviewed evidence. Expanded panels (≥6 pathogens) are only covered when targeted testing is inappropriate and additional panel-specific criteria are met (e.g., specialist ordering, critical illness, documented high-risk exposure for UG/AG); repeat testing is restricted (generally not within 14 days) with limited exceptions and tests must meet CLIA/FDA and MolDX/Technical Assessment requirements when applicable.

"Outpatient molecular syndromic panels (>1 pathogen detected) are covered when all general coverage criteria in this policy are met."

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