Transcription of Gastrointestinal Pathogen Nucleic Acid Detection Panel ...
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Gastrointestinal Pathogen Nucleic Acid Detection Panel ...
Gastrointestinal Pathogen Nucleic acid Detection Panel Testing for Infectious Diarrhea Page 1 of 11 UnitedHealthcare Commercial Medical Policy Effective 04/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. UnitedHealthcare Commercial Medica l Policy Gastrointestinal Pathogen Nucleic acid Detection Panel Testing for Infectious Diarrhea Policy Number: 2022T0604E Effective Date: April 1, 2022 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 2 Applicable Codes .. 2 Description of Services .. 2 Clinical 3 Food and Drug 9 References .. 9 Policy History/Revision Information .. 11 Instructions for 11 Coverage Rationale The following are proven and medically necessary: Multiplex polymerase chain reaction (PCR) Panel testing of Gastrointestinal pathogens of up to 5 targets when performed as part of an evaluation that includes blood cultures for an individual with any of the following: o Diarrhea for more than 7 days with any of the following: fever; or bloody or mucoid stools; or severe abdominal cramping or tenderness; or
Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing for Infectious Diarrhea Page 2 of 10 UnitedHealthcare Commercial Medical Policy Effective 03/01/2021 Proprietary Information of UnitedHealthcare.
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