Lab: Special Histochemical Stains and Immunohistochemical Stains

Special histochemical and immunohistochemical stains are covered when medically necessary to produce a complete, accurate diagnosis that is used to manage the patient and when the pathologist documents the reason, specific block(s), markers, and results in the surgical pathology report. Pathologists must review the routine H&E prior to ordering most additional stains (with limited exceptions such as renal, liver, neuromuscular biopsies or suspected infection), unnecessary routine or reflex testing (including standing orders for Ki-67/EGFR on all breast cancers and chemosensitivity panels) and IHC that does not provide actionable information are not covered.

"Special histochemical and immunohistochemical (IHC) stains are medically necessary when needed to produce a complete and accurate diagnosis that will be reported to and used by the treating physici..."

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