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Regence BlueShieldAll Plans · Coverage · Coding · Infectious Disease, PathologyMedium impact

Identification of Microorganisms Using Nucleic Acid Probes

Effective date
Oct 1, 2026
Identified
Oct 7, 2026

Summary

Effective October 1, 2026, nucleic acid probe testing with or without quantification may be considered medically necessary for BK virus, cytomegalovirus, hepatitis B, hepatitis C, hepatitis D, HIV-1, HIV-2, human herpesvirus 6 and influenza virus. Respiratory pathogen panels with 12 or more targets are considered not medically necessary. Quantification for other microorganisms, hepatitis G testing, central nervous system pathogen panels, urinary tract infection panels, joint infection panels, endometrial pathogen panels, pathogen panels for surgical or chronic wounds and oral HPV testing are considered investigational.

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What to do

Action · 4 steps
01Already effective October 1, 2026: Billing team: Do not report a quantification code together with a direct or amplified probe code for the same test, because simultaneous coding for both is not warranted.
02Do not bill respiratory pathogen panels with 12 or more targets as medically necessary, because the policy considers them not medically necessary.
03Contracts exclude from coverage services considered investigational, which includes quantification for other microorganisms, central nervous system, urinary tract, joint, endometrial and wound pathogen panels, hepatitis G testing and oral HPV testing.
04Route SARS-CoV-2 testing to COVID-19 Testing, Laboratory, Policy No. 74, which is addressed in a separate policy.

Codes mentioned

874958749687497875168751787520875218752287523875348753587536875378753887539875318753287533875018750287503876338748387627875258752687527

Original notice

Identification of Microorganisms Using Nucleic Acid Probes
beonbrand.getbynder.com · Always check the source before changing claims.
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Related changes

See all Regence BlueShield changes →
Identification of Microorganisms Using Nucleic Acid ProbesMediumEffective Oct 1, 2026 · CodingBrowse every Regence BlueShield change in the policy list

Related policy hubs

Regence BlueShield policiesInfectious DiseasePathologyCode 87495Code 87496Code 87497Code 87516Code 87517Code 87520Code 87521Code 87522Code 87523Code 87534Code 87535Code 87536Code 87537Code 87538Code 87539Code 87531Code 87532Code 87533Code 87501Code 87502Code 87503Code 87633Code 87483Code 87627Code 87525Code 87526Code 87527

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