Lab: Special Histochemical Stains and Immunohistochemical Stains

Special histochemical and immunohistochemical stains are covered when they are necessary to render a complete, actionable diagnosis that is documented in the surgical pathology report and used by the treating physician. Routine pre-ordering or reflex staining prior to pathologist review, tests that do not change management, routine staining in morphologically negative specimens (e.g., prostate), chemosensitivity panels, and standing orders for biomarkers (except specified indications like Ki-67 for ER+/HER2- node-positive high-risk breast cancer to guide abemaciclib) are not reasonable and are not covered.

"Special histochemical and immunohistochemical (IHC) stains are medically necessary when required to produce a complete and accurate diagnosis that is communicated to and used by the treating physic..."

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