News

Effective July 1, 2024: New Clinical Policies: Infectious Disease - Lab Screening and Testing

Date: 05/10/24

Managed Health Services (MHS) HealthPlan presents new clinical policies to provide payment protocols for Infectious Disease Primary and Preventive Care Lab Screenings and Lab Testing related to Infectious Diseases. The following policies have been posted on MHS Policy page for review, prior to their implementation:

POLICY	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS	APPLICABLE PRODUCT
CG.CP.MP.105 Infectious Disease Primary Care and Preventive Lab Screening	In some instances, testing of healthy/asymptomatic individuals for infectious diseases is recommended as part of public health prevention and minimization of harm efforts. This policy outlines criteria for human papillomavirus (HPV), hepatitis C virus (HCV), and group B streptococcus (GBS).	Marketplace Medicare
CG.CP.MP.01 Infectious Disease: Respiratory Lab Testing	Seasonal influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 infect many individuals each year. Diagnostic testing for upper respiratory tract infections can be very useful for clinicians, as clinical signs and symptoms of these infections can have significant overlap between pathogens. This policy outlines criteria for Syndromic/Multiplex Respiratory Panels with 6 or More Targets, SARS-CoV-2, RSV, or Influenza A/B, OR Multiplex Respiratory Viral Panels with 5 or Fewer Targets, Bacterial Respiratory Infection/Pneumonia Panels, Influenza A and B Antibody Tests, Group A Streptococcus Pharyngitis Tests, Group A Streptococcus Pharyngitis Cultures, and Group A Streptococcus Antibody Tests.	Marketplace Medicare
CG.CP.MP.02 Infectious Disease: Multi-System Lab Testing	Some pathogens cause infections with symptoms that affect a primary body system, while others cause infections that affect multiple body systems. This policy outlines the appropriate use of tests for pathogens that can cause multisystem symptoms and/or infections. Tests for pathogens that infect multiple body systems can be targeted to detect a specific pathogen(s) or non-targeted to broadly detect nucleic acid from any potential pathogen.	Marketplace Medicare
CG.CP.MP.03 Infectious Disease: Dermatologic Testing	Fungal infection of the nails (onychomycosis) is common. Confirmatory testing should be performed to confirm fungal infection before initiating treatment to prevent inappropriate use of antifungal medications. This policy outlines the appropriate use of Microscopy/Peroxidase Tests, Fungal Culture, and Culture-Independent Molecular Tests (NAAT/PCR) for Onychomycosis.	Marketplace Medicare
CG.CP.MP.104 Infectious Disease: Gastroenterologic Lab Testing	Infections of the gastrointestinal (GI) tract represent a significant cause of infectious disease worldwide. GI infections can be caused by several pathogen types, including bacteria, viruses, fungi, and parasites (e.g., protozoal illnesses such as giardiasis). This policy outlines appropriate use of multi-pathogen panels, as well as diagnostic assays targeted at Helicobacter pylori (H. pylori).	Marketplace Medicare
CG.CP.MP.06 Infectious Disease: Vector-Borne and Tropical Diseases Lab Testing	This policy outlines criteria for Lyme disease and Zika virus testing via serologic and molecular methods.	Marketplace Medicare
CG.CP.MP.07 Infectious Disease: Genitourinary Lab Testing	Cultures, microscopic examination, and molecular identification are all common testing methods for evaluating the infectious causes of various genitourinary conditions. This policy outlines criteria for Targeted Vaginitis/Vaginosis Pathogen Testing, Expanded Multiplex Vaginitis/Vaginosis Pathogen Panels, Urine Culture for Asymptomatic Bacteriuria, and Molecular/Multiplex UTI Panels.	Marketplace Medicare

POLICY

NEW
POLICY OVERVIEW OR UPDATED POLICY REVISIONS

APPLICABLE PRODUCT

CG.CP.MP.105

Infectious Disease Primary
Care and Preventive Lab Screening

In some instances, testing of healthy/asymptomatic individuals for infectious diseases is recommended as part of public health prevention and minimization of harm efforts. This policy outlines criteria for human papillomavirus (HPV), hepatitis C virus (HCV), and group B streptococcus (GBS).

Marketplace

Medicare

CG.CP.MP.01

Infectious Disease:
Respiratory Lab Testing

Seasonal influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 infect many individuals each year. Diagnostic testing for upper respiratory tract infections can be very useful for clinicians, as clinical signs and symptoms of these infections can have significant overlap between pathogens. This policy outlines criteria for Syndromic/Multiplex Respiratory Panels with 6 or More Targets, SARS-CoV-2, RSV, or Influenza A/B, OR Multiplex Respiratory Viral Panels with 5 or Fewer Targets, Bacterial Respiratory Infection/Pneumonia Panels, Influenza A and B Antibody Tests, Group A Streptococcus Pharyngitis Tests, Group A Streptococcus Pharyngitis Cultures,
and Group A Streptococcus Antibody Tests.

Marketplace

Medicare

CG.CP.MP.02

Infectious Disease:
Multi-System Lab Testing

Some pathogens cause infections with symptoms that affect a primary body system, while others cause infections that affect multiple body systems. This policy outlines the appropriate use of tests for pathogens that can cause multisystem symptoms and/or infections. Tests for pathogens that infect multiple body
systems can be targeted to detect a specific pathogen(s) or non-targeted to broadly detect nucleic acid from any potential pathogen.

Marketplace

Medicare

CG.CP.MP.03

Infectious Disease: Dermatologic
Testing

Fungal infection of the nails (onychomycosis) is common.

Confirmatory testing should be performed to confirm fungal infection before initiating treatment to prevent inappropriate use of antifungal medications. This policy outlines the appropriate use of Microscopy/Peroxidase Tests, Fungal Culture, and Culture-Independent Molecular Tests (NAAT/PCR) for Onychomycosis.

Marketplace

Medicare

CG.CP.MP.104

Infectious Disease:
Gastroenterologic Lab Testing

Infections of the gastrointestinal (GI) tract represent a significant cause of infectious disease worldwide. GI infections can be caused by several pathogen types, including bacteria, viruses, fungi, and parasites (e.g., protozoal illnesses such as giardiasis). This policy outlines appropriate use of multi-pathogen panels, as well as diagnostic assays targeted at Helicobacter pylori (H. pylori).

Marketplace

Medicare

CG.CP.MP.06

Infectious Disease:
Vector-Borne and Tropical Diseases Lab Testing

This policy outlines criteria for Lyme disease and Zika virus testing via serologic and molecular methods.

Marketplace

Medicare

CG.CP.MP.07

Infectious
Disease: Genitourinary Lab Testing

Cultures, microscopic examination, and molecular identification are all common testing methods for evaluating the infectious causes of various genitourinary conditions. This policy outlines criteria for Targeted Vaginitis/Vaginosis Pathogen Testing, Expanded Multiplex Vaginitis/Vaginosis Pathogen Panels, Urine Culture for Asymptomatic Bacteriuria, and Molecular/Multiplex UTI Panels.

Marketplace

Medicare