Cigna NAAT panels Coverage & Coding Update

Coverage Criteria

Medically Necessary — STD and related pathogen testing

Covered when EITHER of the following are met:

Asymptomatic high-risk screening: Asymptomatic individual with high-risk behavior (e.g., exposure to possible infected partner), high-risk condition (e.g., pregnancy, HIV), high-risk experience (e.g., assault), chlamydia screening in sexually active individuals, gonorrhea screening in sexually active individuals, or HPV cervical cancer screening.

CPT codes listed for specific pathogens apply

Symptomatic individuals: Symptomatic individual consistent with suspected diagnosis listed in the Coding Information section (examples: Candida, Chlamydia trachomatis, Gardnerella vaginalis, Herpes Simplex Virus, Neisseria gonorrhoeae, high-risk HPV, Trichomonas vaginalis) and tested with the CPT/PLA codes referenced in the policy.

See coding list in document (chunk 4)

Medically Necessary — Panel testing

Covered when ALL of the following are met for panels:

Respiratory panel: Respiratory pathogen nucleic acid panel testing when clinically indicated, limited to panels of approximately 3–5 targets and not to exceed one test per date of service, up to 12 tests per 12 rolling months.one test per date of service; up to 12 per 12 months; ~5 targets

Applies to listed respiratory multiplex codes (e.g., 87631, 87636, 87637, 0240U, 0241U)

Gastrointestinal panel: Gastrointestinal pathogen nucleic acid panel testing when clinically indicated for panels of up to 3–5 targets (policy references up to 5 targets for outpatient use).up to 5 targets

See policy statement on panels (chunks 5, 19)

Central nervous system panel: Expanded central nervous system nucleic acid panels (approximately 12–25 targets) may be considered clinically useful when indicated by presentation and clinical assessment.12-25 targets

See policy statement on CNS panels (chunk 5, 19)

Medically necessary nucleic acid tests (selected)

Considered medically necessary when criteria in the applicable policy statements listed above are met:

Chlamydia testing: NAATs for Chlamydia trachomatis (CPT 87490, 87491, 87492) are considered medically necessary when the policy criteria are met and the test is billed with an applicable ICD-10 diagnosis listed in the policy (examples: A54.00–A54.9, A55, A56.00–A56.8, A64, B20, B97.35).

See ICD-10 lists in chunk 36 for full diagnoses

Candida testing (direct): Nucleic acid detection for Candida species (CPT 87480, 87481) is considered medically necessary when policy criteria are met and associated ICD-10 indications are present; quantitative Candida testing CPT 87482 is listed as not covered.

Quantification (87482) is not covered (chunk 34)

Chlamydia testing — medically necessary

Covered when ALL of the following are met:

Chlamydia testing coverage: CPT 87490, 87491, 87492 are considered medically necessary when criteria in the applicable policy statements are met and when billed with one of the listed ICD-10 diagnoses (examples include A54.00–A54.9, A55, A56.00–A56.8, A64, A71.0–A71.9, A74.0–A74.9, B20, B97.35).

See ICD-10 lists in chunk 36 for full diagnoses

Gardnerella / BV testing — medically necessary

Covered when ALL of the following are met:

Gardnerella/BV testing coverage: CPT 81513 and CPT 87510–87511 are considered medically necessary when criteria in the applicable policy statements are met and when billed with applicable ICD-10 diagnoses listed in the policy (examples include B20, B97.35, N30.80–N30.81, N34.1, N76.0, O00.00–O9A.53, R30.0).

CPT 87512 (quantification) is listed as not covered for all ICD-10 codes (chunk 47)

Herpes simplex testing — medically necessary

Covered when ALL of the following are met:

Herpes simplex testing coverage: CPT 87528 and CPT 87529 are considered medically necessary when policy criteria are met and when billed with applicable ICD-10 diagnoses listed in the policy (examples include A60.00–A60.9, A64, A85.8, A86, A87.8–A87.9, B00.1–B00.9, B09, B20, B97.35 and CNS/ocular infection codes).

CPT 87530 (quantification) is listed as not covered (chunk 55)

General medical necessity linkage

Considered Medically Necessary when criteria in the applicable policy statements listed above are met:

Diagnosis-linked coverage: Coverage applies when the submitted CPT is associated with one of the specified ICD-10 encounter, screening, exposure, pregnancy, transplant, symptomatic infection, or disease diagnosis codes or ranges listed in the policy (examples include screening codes Z11.x, exposure codes Z20.x, pregnancy/obstetric codes Z32–Z39, transplant status Z48.21–Z48.298, and numerous STI and symptomatic diagnosis codes).

See ICD-10 code lists in chunks 54–65 and adjacent sections for full lists

Infectious pathogen panel medical necessity and frequency

Infectious Pathogens panels

Panel coverage limitation: Infectious pathogen multiplex panels are considered medically necessary when the policy criteria are met and are limited to one test per date of service and up to 12 tests per 12 rolling months.1 per date; 12 per 12 months

Applies to listed respiratory multiplex codes (e.g., 87631, 87636, 87637, 0240U, 0241U) and similar panels

Specific NAAT coverage

Pathogen-specific NAATs and related diagnoses

Covered pathogen NAATs: Specific pathogen-targeted NAAT CPT/PLA codes (for example, respiratory, CNS, GI, and genitourinary pathogen codes such as 87483, 87505, 0353U [deleted 06/30/2024]) are considered medically necessary when policy criteria are met and when billed with applicable ICD-10 diagnoses listed in the policy.

See adjacent ICD-10 diagnosis lists to support medical necessity

General medical necessity for molecular infectious pathogen testing

Covered when ALL of the following are met:

General requirement: Testing using molecular nucleic acid methods for infectious pathogens is considered medically necessary when the applicable policy statements above are met and when the test order is supported by an appropriate ICD-10 encounter, screening, exposure, pregnancy, transplant, or symptomatic diagnosis as listed in the policy.

See ICD-10 code lists in chunks 90–92 for supporting codes and encounter types

Not Medically Necessary — Panels not meeting criteria

Not covered when ANY of the following apply:

Not covered panel tests: Infectious pathogen detection by nucleic acid panel testing that does not meet the criteria in the policy is Not Covered or Reimbursable; numerous multiplex panel CPT/HCPCS/U-codes (including but not limited to 87506, 87507, 87632, 87633, 0115U, 0152U, 0202U, 0223U, 0225U, 0330U, 0354U, 0371U, 0441U, 0442U, 0502U, 0504U, 0505U, 0528U, and other listed U-codes) are enumerated as not covered when criteria are not met.

See chunks 100–103 for the full list of not covered panel codes

Nucleic acid pathogen tests and panels performed in the outpatient setting that do not meet the medical necessity criteria described in this policy will be denied as Not Covered or Reimbursable. Claims submitted without an appropriate supporting diagnosis or without meeting the criteria and frequency limits set in the policy may be denied.

Quantitative Candida nucleic acid testing (CPT 87482) is categorized as Not Covered or Reimbursable when performed in the outpatient setting for the listed ICD-10-CM diagnoses. The policy enumerates multiple related ICD-10 codes (e.g., candidiasis and urogenital/skin-nail conditions) that are included in this Not Covered designation.

CPT 87512 (Gardnerella vaginalis quantification) is listed as Not Covered or Reimbursable for all ICD-10-CM codes in the policy; quantification for Gardnerella is not a covered service in the outpatient setting under this policy.

CPT 87530 (Herpes simplex virus quantification) is designated Not Covered or Reimbursable for all ICD-10-CM codes shown in the policy; HSV quantification is not covered in the outpatient setting per this policy.

Several specific CPT codes are listed as Not Covered or Reimbursable regardless of the associated diagnosis; examples called out in the document include CPTs such as 87530 (HSV quantification), 87592 (Neisseria gonorrhoeae quantification), and 87623 (HPV low‑risk types).

Use of nonspecific or Not Otherwise Specified NAAT CPT codes (87797, 87798, 87799) for molecular microbe testing is listed as Not Covered or Reimbursable when a more specific CPT/HCPCS code is available.

The policy explicitly states that ICD-10-CM codes not listed in the provided coverage lists are considered Not Covered or Reimbursable for outpatient nucleic acid pathogen testing; in other words, 'all other codes' not included in the supporting diagnosis lists are not covered.

Nucleic acid quantification to monitor disease progression or therapeutic response is not covered for certain pathogens under this policy. Specifically, quantification for Gardnerella vaginalis, non‑invasive Candida, Neisseria gonorrhoeae, and herpes simplex virus (HSV) types 1 & 2 is not considered medically necessary for outpatient monitoring.

Expanded multiplex panels that include greater than 5 targets for respiratory or gastrointestinal pathogens lack established clinical utility in the outpatient setting and are not considered supported by the published peer‑reviewed literature; such large multiplex panels may be designated Not Covered unless they meet the policy criteria.

For coding and reimbursement purposes, ICD-10-CM diagnosis codes that are not explicitly listed in the policy’s supporting diagnosis lists are treated as Not Covered or Reimbursable when submitted for outpatient nucleic acid pathogen testing.

The policy specifically identifies quantification CPTs and HPV low‑risk testing as not covered: nucleic acid quantification for herpes simplex (87530), Neisseria gonorrhoeae quantification (87592), and HPV low‑risk type testing (87623) are explicitly listed as Not Covered or Reimbursable.

The document lists numerous ICD-10-CM codes tied to non‑infectious dermatologic, musculoskeletal, urinary stone, chronic cystitis, urethral stricture, benign prostatic hypertrophy and other non‑infectious conditions as contexts in which nucleic acid pathogen testing is Not Covered or Reimbursable in the outpatient setting.

A broad set of molecular microbe multiplex panel CPT/HCPCS/U‑codes and advanced molecular tests (including many U‑codes and higher‑order multiplex CPTs) are listed as Not Covered or Reimbursable when the policy criteria are not met; the policy enumerates numerous panel codes that will not be reimbursed in those circumstances.

Covered Indications

Diagnosis and screening of specific STDs and related infections (Candida, Chlamydia, Gardnerella/BV, Gonorrhea, HSV, high-risk HPV, Trichomonas)

Diagnosis and screening of specific STDs and related infections:

STD and related infections: Testing for Candida, Chlamydia trachomatis, Gardnerella vaginalis/BV, Neisseria gonorrhoeae, Herpes simplex virus types 1 and 2, high-risk HPV types, and Trichomonas vaginalis is considered medically necessary for asymptomatic high-risk screening or symptomatic individuals when policy criteria and applicable ICD-10 codes are met.

See CPT and ICD-10 code listings in the policy (chunks 4, 11–16, 18)

Respiratory, gastrointestinal, and CNS pathogen panels when criteria and target limits are met

Respiratory, gastrointestinal, and central nervous system pathogen panels when criteria and target limits are met:

Respiratory/GI/CNS panels: Respiratory panels: limited to approximately 3–5 targets and subject to frequency limits (one test per date of service; up to 12 tests per 12 rolling months). Gastrointestinal panels: generally limited to up to 3–5 targets. Central nervous system panels: expanded panels (approximately 12–25 targets) may be considered clinically useful when indicated.

Coding (CPT/HCPCS/ICD-10)

Covered/Referenced CPT/HCPCS codes for specific pathogensmixed

81514	Candida (listed with other codes in document)
87480	Candida
87481	Candida
0352U	Candida / Trichomonas (listed)
81515	Candida / Trichomoniasis (listed)
87490	Chlamydia trachomatis
87491	Chlamydia trachomatis
87492	Chlamydia trachomatis
0353U	Chlamydia / Gonorrhea (listed)
81513	Gardnerella vaginalis

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Considered Medically Necessary (selected CPT)CPTCovered

87480	Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique.
87481	Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique
87490	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique.
87491	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique.
87492	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification

Not Covered or Reimbursable (selected CPT)CPTNot Covered

87482

Infectious agent detection by nucleic acid (DNA or RNA); Candida species, quantification

Diagnosis codes referenced in medically necessary listsICD-10

B20	Human immunodeficiency virus [HIV] disease.
B37.31	Acute candidiasis of vulva and vagina.
N39.0	Urinary tract infection, site not specified.
A54.00-A54.9	Gonococcal infection.
A56.00-A56.8	Other sexually transmitted chlamydial diseases.

Diagnosis codes listed under Not Covered or ReimbursableICD-10Not Covered

B37.0	Candidal stomatitis.
B37.2	Candidiasis of skin and nail.
N72	Inflammatory disease of cervix uteri.
N76.0	Acute vaginitis.

Chlamydia testing CPT codesCPTCovered

87490	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique.
87491	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique.
87492	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification.

Gardnerella / BV testing CPT codesCPT

81513	Infectious disease, bacterial vaginosis, quantitative real-time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species, algorithm reported as a positive or negative result for bacterial vaginosis.
87510	Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, direct probe technique.
87511	Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique.
87512	Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, quantification.

Herpes simplex testing CPT codesCPT

87528	Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, direct probe technique.
87529	Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique.
87530	Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, quantification.

Not Covered CPT CodesCPTNot Covered

87530

Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, quantification

Not Covered CPT CodesCPTNot Covered

87592	Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, quantification
87623	Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44)

Covered CPT Codes (when criteria met)CPTCovered

87590	Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique
87591	Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique

Covered CPT Codes (when criteria met)CPTCovered

87624	Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types
87626	Infectious agent detection by nucleic acid (DNA or RNA); HPV separately reported high-risk types and pooled result(s)

Not Covered CPT/HCPCS CodesCPTNot Covered

87797	Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism.
87798	Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism.
87799	Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism

Covered/Considered Medically Necessary NAAT CodesCPT|PLACovered

87631	Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus, multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 3-5 targets.
87636	Infectious agent detection by nucleic acid (DNA or RNA); SARS-CoV-2 and influenza A/B, multiplex amplified probe technique.
87637	Infectious agent detection by nucleic acid (DNA or RNA); SARS-CoV-2, influenza A/B, and RSV, multiplex amplified probe technique.
0240U	Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (SARS-CoV-2, influenza A, influenza B), upper respiratory specimen.
0241U	Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (SARS-CoV-2, influenza A, influenza B, RSV), upper respiratory specimen.
87483	Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen, includes multiplex reverse transcription and amplified probe technique, 12-25 targets.
87505	Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen, includes multiplex reverse transcription and amplified probe technique, 3-5 targets.
0353U	Infectious agent detection by nucleic acid (DNA), Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique, urine/vaginal/pharyngeal/rectal (code deleted 06/30/2024).

Considered Medically Necessary ICD-10 Codes (examples)ICD-10

Z20.5	Contact with and (suspected) exposure to viral hepatitis.
Z20.6	Contact with and (suspected) exposure to human immunodeficiency virus [HIV].
Z21	Asymptomatic human immunodeficiency virus [HIV] infection status.
Z23	Encounter for immunization.
Z32.01	Encounter for pregnancy test, result positive.
Z34.00	Encounter for supervision of normal pregnancy (examples listed as ranges).
Z11.4	Encounter for screening for human immunodeficiency virus [HIV].
A54.00	Gonococcal infection (example of listed ICD ranges related to STIs).

Covered/Considered Medically Necessary molecular codes (selected)CPT | HCPCS | mixedCovered

81514	Infectious disease, bacterial vaginosis and vaginitis, quantitative real-time amplification of DNA markers..., algorithm reported as a positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and/or Candida species...
81515	Infectious disease, bacterial vaginosis and vaginitis, real-time PCR amplification of DNA markers..., algorithm reported as positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and Candida species...
0352U	Infectious disease (bacterial vaginosis and vaginitis), multiplex amplified probe technique, detection of BV-associated bacteria and separate detection of Candida species and trichomonas vaginalis; (Code deleted 12/31/2024).

Not Covered or Reimbursable panel and advanced molecular codesCPT | HCPCS | U-codeNot Covered

87506	Gastrointestinal pathogen nucleic acid panel, 6-11 targets
87507	Gastrointestinal pathogen nucleic acid panel, 12-25 targets
87632	Respiratory virus nucleic acid panel, 6-11 targets
87633	Respiratory virus nucleic acid panel, 12-25 targets
0115U	Respiratory infectious agent detection by nucleic acid, 18 viral types and subtypes and 2 bacterial targets, each analyte reported as detected or not detected
0152U	Infectious disease (bacteria, fungi, parasites, and DNA viruses), PCR and NGS, plasma, detection of >1,000 potential microbial organisms
0202U	Pathogen-specific nucleic acid RT-PCR, 22 targets including SARS-CoV-2
0223U	Pathogen-specific nucleic acid, 22 targets including SARS-CoV-2
0225U	Pathogen-specific DNA and RNA, 21 targets including SARS-CoV-2
0330U	Infectious agent detection by nucleic acid, vaginal pathogen panel, 27 organisms

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Not covered when more specific CPT/HCPCS code is availableCPTNot Covered

87797	Infectious agent detection by nucleic acid, not otherwise specified; direct probe technique, each organism
87798	Infectious agent detection by nucleic acid, not otherwise specified; amplified probe technique, each organism
87799	Infectious agent detection by nucleic acid, not otherwise specified; quantification, each organism

Selected ICD-10-CM codes listed as considerations for medical necessityICD-10

Z11.4	Encounter for screening for human immunodeficiency virus [HIV]
Z11.51	Encounter for screening for human papillomavirus (HPV)
Z20.6	Contact with and (suspected) exposure to human immunodeficiency virus [HIV]
Z23	Encounter for immunization
Z30.430	Encounter for insertion of intrauterine contraceptive device
Z32.01	Encounter for pregnancy test, result positive
A59.00	Trichomoniasis (example ICD-10 series included)
B37.31	Acute candidiasis of vulva and vagina

inv-44: Respiratory panel frequency/target threshold

Frequency limitOne test per date of service; up to 12 tests per 12 rolling months

Target count (outpatient)Panels generally limited to up to 5 targets

Denial risk for excess useUse beyond frequency or target limits may be considered not clinically useful and denied

Provider Actions and Billing Guidance

Prior Authorization

Prior Authorization / Plan Review

Prior authorization and utilization review may apply. Nucleic acid testing codes listed as medically necessary (e.g., chlamydia, Gardnerella/BV, herpes simplex, high‑risk HPV) must meet the policy clinical criteria and be linked to an appropriate ICD‑10 diagnosis on the claim; tests performed in outpatient settings that do not meet medical necessity criteria will be denied.

Submit supporting documentation (history, symptoms, exposure, prior positive cultures where required) and include the applicable ICD‑10 code(s) from the policy lists.
Multiplex panels that do not meet the policy criteria are Not Covered or Reimbursable and may require prior authorization when plan benefit language applies.

Prior Authorization

Chlamydia NAAT — Provider Authorization and Documentation

Chlamydia NAAT CPT codes 87490, 87491, 87492 are considered medically necessary only when the applicable policy criteria are met and an appropriate ICD‑10 diagnosis from the policy list is submitted on the claim.

Ordering Requirements

Documentation Required

Ordering requirement — include appropriate codes and follow utilization review

Providers must submit orders and claims with appropriate diagnosis and procedure codes and follow any plan utilization review or prior authorization processes; medical directors may exercise clinical judgment in individual determinations.

Claims not accompanied by covered codes or supporting documentation per the policy may be denied.

Documentation Required

Ordering requirement — clinical assessment and specimen guidance

Clinical assessment and documentation are required to support testing—e.g., for recurrent uncomplicated UTI clinicians must document prior positive urine cultures associated with symptomatic episodes and obtain urinalysis and urine culture and sensitivity with each symptomatic episode prior to treatment; follow specimen selection guidance in the policy.

Frequency Limits

inv-102: Respiratory nucleic acid pathogen panel (up to ~5 targets)

Test per dateOne test per date of service

12-month capUp to 12 tests per 12 rolling months

Respiratory exampleRespiratory multiplex codes (87631, 87636, 87637, 0240U, 0241U) follow these limits

inv-103: Urinalysis, urine culture and sensitivity (in recurrent UTI patients prior to initiating treatment)

TimingObtain urinalysis, urine culture and sensitivity with each symptomatic acute cystitis episode in recurrent UTI patients prior to initiating treatment

DocumentationClinicians must document prior positive urine cultures associated with symptomatic episodes for recurrent UTI management

Not Covered or Reimbursable

Not covered test examples called out in the policy include HPV low‑risk type testing, syphilis NAAT, tests for nail dystrophy and skin/nail fungal infections (including tinea/dermatophytes), certain urinary tract infection NAATs, quantitative Candida testing (CPT 87482), and a large list of multiplex and unspecified NAAT codes that are not reimbursable when policy criteria are not met.

Quantitative Candida testing (CPT 87482) and the ICD-10-CM diagnoses listed in the policy (for example, candidal stomatitis, candidiasis of skin and nail, vulvovaginal candidiasis and related urogenital codes) are identified as Not Covered or Reimbursable when performed in the outpatient setting without meeting medical necessity criteria.

Nucleic acid pathogen testing for tinea/dermatophyte infections is not supported by professional guidance; IDSA recommends culture, calcofluor‑KOH preparation and histopathology rather than NAAT for dermatophyte diagnosis, and the policy lists tinea testing by NAAT as Not Covered.

CPT 87512 (Gardnerella vaginalis quantification) is explicitly listed as Not Covered or Reimbursable for all ICD-10‑CM codes in the policy; quantification of Gardnerella is not supported as a covered outpatient service.

CPT 87530 (Herpes simplex virus quantification) is explicitly listed as Not Covered or Reimbursable for all ICD-10‑CM codes in the policy; HSV quantification for outpatient claims will not be reimbursed under this policy.

The policy contains a generic statement that ICD-10‑CM codes not listed in the supporting diagnosis lists are Not Covered or Reimbursable; providers should only bill covered NAATs when the encounter is linked to an applicable ICD‑10 code from the policy lists.

Background

Nucleic acid amplification tests (NAATs) detect pathogen DNA or RNA from clinical specimens and commonly use amplification methods to increase diagnostic sensitivity and lower limits of detection. NAATs are widely used for sexually transmitted infections and for respiratory, gastrointestinal, and central nervous system pathogen detection; however, standard laboratory methods (culture, microscopy, serology) remain the diagnostic standard for certain organisms.

inv-82: Definition — Nucleic acid amplification test (NAAT)

DefinitionA test that amplifies tiny amounts of pathogen DNA or RNA to increase diagnostic sensitivity and lower limits of detection.

AcronymNAAT = Nucleic Acid Amplification Test

UseCommonly applied to detect viruses, bacteria, parasites and fungi from clinical specimens

inv-83: Definition — Nucleic acid quantification

Definition

Definitions

inv-82: NAAT definition (amplifies tiny amounts of pathogen DNA/RNA to increase sensitivity)

DefinitionA test that amplifies tiny amounts of pathogen DNA or RNA to increase diagnostic sensitivity and lower limits of detection

SynonymAlso referred to as NAAT

SpecimensApplicable to blood, tissue, body fluid, sputum, stool, urine, cerebrospinal fluid

inv-83: Nucleic acid quantification definition (measurement of concentration vs presence/absence)

DefinitionMeasurement of the concentration of pathogen DNA or RNA rather than just presence/absence

PurposeUseful for latent viruses or monitoring therapy when supported by evidence

Revision History

2025-02-15focused review - coding updateLatest

Focused review updated coding (coding changes).

2024-11-10focused review - administrative

Focused review noted no clinical policy statement changes.

2024-05-15annual review - policy addition

Annual review added a policy statement for antibiotic resistant testing.

OpenPayer

Nucleic acid infectious pathogen testing (NAAT/NAAT panels)

Coverage Criteria

Covered Indications

Coding (CPT/HCPCS/ICD-10)

Provider Actions and Billing Guidance

Ordering Requirements

Frequency Limits

Not Covered or Reimbursable

Background

Definitions

Revision History