| Medical Policy | Revision |
|---|---|
| Hepatitis Testing AHS – G2036 | Reviewed by Avalon 3rd Quarter 2025 CAB. Updated Description, Policy Guidelines, and References. When Covered section updated as follows: Added additional high-risk situation for the triple panel testing for Hepatitis B and now reads as follows, “For individuals who are receiving immunosuppressant therapy.” Addition of once every three-month frequency to antibody testing for HCV. Addition of “for individuals who are immunocompromised” to qualitative nucleic acid testing for HCV. Billing and Coding section updated as follows: added HCPCS code G0567. Medical Director review 7/2025. Notification given 10/15/2025 for effective date 12/10/2025. |
| Identification of Microorganisms using Nucleic Acid Probes AHS – M2097 | Reviewed by Avalon 3rd Quarter 2025 CAB. Updated Description, Policy Guidelines and References. Changes to coverage criteria: Removed “Non-vaginal Candida species” and associated codes from the table under the Not Covered section. Direct probe testing for Chlamydia pneumoniae, Cytomegalovirus, Legionella pneumophila, and Mycoplasma pneumoniae all moved from the When Covered section to Not Covered. All direct probes in policy are now under the Not Covered section. Second coverage criteria under Not Covered section updated to remove phrase "any combination of direct probe" and "or" and now reads "Reimbursement is not allowed for simultaneous ordering of amplified probe and quantification for the same organism in a single encounter." Removed codes 87480, 87481 and 87482 from Billing/Coding section. Medical Director review 7/2025. Notification given 10/15/2025 for effective date 12/10/2025. |
| Pancreatic Enzyme Testing for Acute Pancreatitis AHS – G2153 | Reviewed by Avalon 3rd Quarter 2025 CAB. Description, Policy Guidelines and References updated. Removed amylase from coverage criteria 1 under the When Covered section. Updates to the Not Covered section: Removed amylase from coverage criteria 1 and 6 (formerly coverage criteria 5), added new coverage criteria 2 that reads "Reimbursement is not allowed for measurement of serum amylase when ordered for anything other than analysis of pancreatic cyst fluid." Medical Director review 7/2025. Notification given 10/15/2025 for effective date 12/10/2025. |
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