Identification of Microorganisms using Nucleic Acid Probes
Defines coverage status (meets or does not meet coverage criteria) for nucleic acid direct probe, amplified probe, and quantification procedures for specific microorganisms and lists applicable CPT codes. Prohibits simultaneous ordering of amplified probe and quantification for the same organism in a single encounter.
No material clinical or coverage changes noted in this update.
Coverage Summary
Scope: This policy (AHS-M2097) defines coverage status for nucleic acid probe-based identification of microorganisms — including direct probe, amplified probe (e.g., PCR/NAAT/FRET), and quantification procedures — by listing organism-specific CPT codes and whether each meets coverage criteria (MCC) or does not meet coverage criteria (DNMCC). It also prohibits simultaneous ordering of amplified probe and quantification for the same organism in a single encounter and notes that final application depends on the individual’s benefit coverage and applicable Medicare/Medicaid regulations.