47536 Insurance Policy Changes

Procalcitonin (PCT) (CPB 0771, reviewed 2025-11-13)

Aetna updated its Procalcitonin (PCT) medical policy (CPB 0771, effective 2025-11-13) to define covered and non-covered uses of CPT code 84145. PCT testing is covered only for risk-stratifying febrile infants aged 8-60 days and for initiating/discontinuing antibiotics in ICU patients and hospitalized patients with respiratory infections. All other uses—including sepsis diagnosis, pneumonia differentiation, cardiac surgery complications, and numerous other clinical scenarios—are classified as experimental/investigational and not covered.