All PlansCoverageMedium impact
Identification of Microorganisms Using Nucleic Acid Probes
Regence BlueShield·Infectious Disease, Pathology, Internal Medicine +2 more·Coding
Effective date
Jan 1, 2026
We identified it
Jun 16, 2026
Summary
New policy GT85 establishes coverage criteria for nucleic acid probe testing for microorganism identification, effective January 1, 2026. Certain tests like respiratory pathogen panels with 12+ targets are not medically necessary, while many other pathogen panels and specific organism tests are considered investigational.
Action Required
Before January 1, 2026: Billing team must update system to flag respiratory pathogen panels with 12+ targets (codes 0115U, 0202U, 0223U, 0225U, 0373U, 0556U, 0563U, 0564U, 87633) as not medically necessary and pathogen panels for CNS, UTI, joint infections, endometrial, and wounds as investigational. Update encounter forms to alert providers that investigational tests may be billed to patients. Review nucleic acid probe orders to ensure only covered organisms (CMV, Hepatitis B/C/D, HIV-1/2, HHV-6, Influenza) are submitted for coverage.