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Multiplex Pathogen Identification Panels for Infectious Disease - MEDICAID - KENTUCKY (Revised)
Effective date
Nov 12, 2025
Identified
Jun 24, 2026
Summary
Humana Kentucky Medicaid has updated coverage criteria for multiplex pathogen identification panels, establishing specific requirements for respiratory infection panels with 6+ targets and covering nucleic acid amplification tests for bacterial vaginitis. The policy excludes certain combination tests and metagenomic sequencing.
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What to do
Action · 2 steps
01Before November 12, 2025: Billing team must update system to apply new coverage criteria for respiratory pathogen panels (87632, 87633) requiring prior targeted testing, immunocompromised status documentation, and symptoms affecting therapeutic management.
02Update encounter forms to capture required criteria and flag non-covered combination tests (0373U) and metagenomic sequencing tests (0152U, 0323U, 0330U) for Kentucky Medicaid members.
Codes mentioned
81513815148763287633
Original notice
Multiplex Pathogen Identification Panels for Infectious Disease - MEDICAID - KENTUCKY (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
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