Identification of Microorganisms Using Nucleic Acid Probes
Summary
Medical Policy GT85, Identification of Microorganisms Using Nucleic Acid Probes, is effective October 1, 2026. Nucleic acid testing using a direct or amplified probe technique, with or without quantification, may be considered medically necessary for BK virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, hepatitis D virus, HIV-1, HIV-2, human herpesvirus 6, and influenza virus. Respiratory pathogen panels with 12 or more targets are considered not medically necessary. Testing with quantification or semi-quantification for other microorganisms, hepatitis G virus testing, central nervous system pathogen panels, urinary tract infection pathogen panels, joint infection panels, endometrial pathogen panels, pathogen panels for surgical or chronic wounds, and oral HPV testing are considered investigational. The technique for quantification includes both amplification and direct probes, so simultaneous coding for quantification with either amplification or direct probes is not warranted. SARS-CoV-2 nucleic acid testing is addressed in a separate policy, COVID-19 Testing, Laboratory, Policy No. 74.
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