CurrentArizona Complete HealthPolicy N/A

Concert Infectious Disease: Multisystem Testing (CMV and Metagenomic Sequencing)

Clinical coverage guidance for laboratory testing of pathogens that cause multisystem infections, focused on cytomegalovirus (CMV) antibody and nucleic acid/antigen testing and on untargeted metagenomic sequencing; intended for outpatient setting and for health plans affiliated with Centene Corporation (Arizona Complete Health).

Policy Summary

PayerArizona Complete Health

PolicyConcert Infectious Disease: Multisystem Testing (CMV and Metagenomic Sequencing)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionWhen ordering CMV antibody or nucleic acid/PCR/antigen tests, document the specific clinical indication(s) (e.g., transplant status, immunocompromised status, neonatal birthweight/gestational age, pregnancy findings, suspected congenital CMV, or negative EBV testing) to support medical necessity; claims for untargeted metagenomic sequencing should be considered investigational and are at risk for denial.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Test categories with explicit coverage stance (CMV antibody; CMV nucleic acid/PCR or antigen detection)

1Test category explicitly considered investigational (untargeted metagenomic sequencing)

8CPT/HCPCS codes listed in policy coding section

Medical Necessity Criteria for CMV and Metagenomic Testing

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.