Medicare AdvantageCoverageHigh impact
Multiplex respiratory pathogen panel coverage
Geisinger Health Plan·PA · Emergency Medicine, Family Medicine, General Practice +4 more·Medical Policy
Effective date
Apr 1, 2025
We identified it
Jul 29, 2026
Summary
Geisinger Health Plan is restricting coverage of CPT code 0202U (BioFire FilmArray Respiratory Panel 2.1) effective April 1, 2025. The multiplex respiratory pathogen panel will only be covered for patients in observation and inpatient status—not for outpatient or emergency department testing. This change applies to all Geisinger plans including Medicare Advantage and Medicaid, and will shift significant out-of-pocket costs to members seeking respiratory testing in office or ED settings.
Action Required
By March 31, 2025: Billing team must update the EMR and billing system to flag CPT 0202U as NON-COVERED for outpatient and emergency care settings under all Geisinger plans. Providers must update encounter forms and clinical workflows to direct patients to inpatient/observation settings for this test or offer alternative testing. Front desk and clinical staff must inform patients requesting respiratory panels that 0202U will not be covered in office or ED visits and alert them to potential out-of-pocket costs before testing. Verify that claims for 0202U from outpatient/ED settings are denied post-April 1. Implement prior authorization rules in billing software to require inpatient/observation status documentation before 0202U claims are submitted.