CurrentAmeriHealth Caritas VIP CarePolicy CCP.1563

Rapid molecular infectious disease testing for Group A Streptococcus

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This policy governs coverage of rapid molecular, nucleic acid amplification, and amplified probe testing for Group A Streptococcus in members with suspected streptococcal pharyngitis. It informs provider coverage determinations and applies subject to plan benefits, applicable law, and individual clinical circumstances.

Policy Summary

PayerAmeriHealth Caritas VIP Care

PolicyRapid molecular infectious disease testing for Group A Streptococcus

Policy CodePolicy CCP.1563

Change TypeNo material change

Effective DateJul 1, 2026

Last ReviewJun 1, 2026

Next Review DateOct 1, 2027

Key ActionDo not consider rapid molecular Group A Streptococcus testing medically necessary for suspected streptococcal pharyngitis.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredCoverage stance

3Molecular testing codes

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CurrentAmeriHealth Caritas VIP CarePolicy CCP.1563

Rapid molecular infectious disease testing for Group A Streptococcus

Customize your policy alerts

Sign up for amerihealth_caritas_vip_care Policy CCP.1563 alerts

Get alerted when Policy CCP.1563 changes without checking for updates manually.

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Policy Summary

PayerAmeriHealth Caritas VIP Care

PolicyRapid molecular infectious disease testing for Group A Streptococcus

Policy CodePolicy CCP.1563

Change TypeNo material change

Effective DateJul 1, 2026

Last ReviewJun 1, 2026

Next Review DateOct 1, 2027

Key ActionDo not consider rapid molecular Group A Streptococcus testing medically necessary for suspected streptococcal pharyngitis.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredCoverage stance

3Molecular testing codes

Coverage Criteria

Rapid molecular Group A Streptococcus testing

Rapid molecular testing is not medically necessary when performed for suspected streptococcal pharyngitis.

Not medically necessary: The service is rapid molecular infectious disease testing for Group A Streptococcus, including nucleic acid amplification or amplified probe testing, in a member with suspected streptococcal pharyngitis.

The policy characterizes the service as investigational/not clinically proven and therefore not medically necessary.

This policy addresses rapid molecular testing for Group A Streptococcus in members with suspected streptococcal pharyngitis, including testing by nucleic acid amplification and amplified probe methods. These services are considered investigational or not clinically proven and are therefore not medically necessary.

Applicable Codes

Rapid molecular Group A Streptococcus testing codes subject to policyCPTExperimental

87650	Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, direct probe technique.
87651	Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique.
87652	Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, quantification.

Alternative standard testing codesCPT

87880	Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A. Included as an alternative standard testing code when rapid antigen detection testing is performed, subject to applicable coding manuals and plan requirements.
87081	Culture, presumptive, pathogenic organisms, screening only. Included as an alternative standard testing code when throat culture is performed, subject to applicable coding manuals and plan requirements.

Provider and Coverage Implications

Denial Risk

Molecular Group A Streptococcus testing is not medically necessary

Do not bill rapid molecular infectious disease testing for Group A Streptococcus as a medically necessary service for members with suspected streptococcal pharyngitis. The policy considers nucleic acid amplification and amplified probe testing investigational/not clinically proven and therefore not medically necessary.

Applies to CPT 87650, 87651, and 87652.
Coverage determination is subject to applicable plan benefits, law, and individual clinical circumstances.

Clinical and Technical Background

Rapid molecular Group A Streptococcus assays detect organism-specific nucleic acid directly from throat swab specimens using nucleic acid amplification or amplified probe technologies. Group A Streptococcus, also known as Group A beta-hemolytic Streptococcus or Streptococcus pyogenes, is a bacterial cause of acute pharyngitis. Although these assays generally have high sensitivity and specificity, positive results may reflect colonization, residual nucleic acid, or nonviable organisms and should be interpreted in the clinical context.

Key Definitions

Rapid molecular infectious disease testing for Group A Streptococcus

DefinitionRapid molecular infectious disease testing for Group A Streptococcus uses nucleic acid amplification or amplified probe technology to detect organism-specific nucleic acid directly from throat swab specimens.

Nucleic acid amplificationA molecular testing approach used to detect organism-specific nucleic acid from a throat swab specimen.

Amplified probe assayA molecular testing approach that uses amplified probe technology to detect organism-specific nucleic acid from a throat swab specimen.

Group A Streptococcus

DefinitionGroup A Streptococcus is a bacterial cause of acute pharyngitis.

Also calledGroup A beta-hemolytic Streptococcus.