Blue Shield of CaliforniaAll Plans · Administrative · Medical Policy · CA · Infectious Disease, Internal Medicine, Pediatrics +7 moreMedium impact
Identification of Microorganisms Using Nucleic Acid Probes (2.04.10)
Effective date
Oct 1, 2026
Identified
Dec 1, 2025
Summary
Blue Shield of California medical policy 2.04.10, Identification of Microorganisms Using Nucleic Acid Probes, has an effective date of October 1, 2026, and its policy statement has no changes from the previous version. Nucleic acid testing without quantification of viral load may be considered medically necessary for listed organisms, including Chlamydia trachomatis, Neisseria gonorrhoeae, influenza virus, SARS-CoV-2, and Streptococcus group A and group B, while testing with quantification of viral load is investigational for organisms not on the medically necessary list. Gardnerella vaginalis and hepatitis G testing are investigational, outpatient respiratory viral panels may be considered medically necessary only when they involve 5 targets or less and the results will guide or alter management, and central nervous system, gastrointestinal and urogenital pathogen panels are investigational.
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01Already effective October 1, 2026: Check the current applicability of this policy version to the services you bill, and direct applicability questions to the Prior Authorization Department at (800) 541-6652.
02Billing team: for nucleic acid testing the policy covers, the documentation to provide is history and physical and/or consultation notes including the clinical condition or diagnosis, the microorganism in question, past and present testing, and the specific test being requested, along with pertinent laboratory and imaging results.
03For post-service claims, also include the results or reports of tests performed.
04For outpatient respiratory viral panels, confirm the panel involves 5 targets or less and that the results will be used to guide or alter management, because panels with 6 or more targets are considered investigational in the outpatient setting.
Codes mentioned
87483875058750687507876318763287633
Original notice
Identification of Microorganisms Using Nucleic Acid Probes (2.04.10)
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