Identification of Microorganisms Using Nucleic Acid Probes (Lab Benefit Program)
This reimbursement policy governs coverage and billing for laboratory tests that identify microorganisms using nucleic acid probe, amplified probe, or quantification techniques for EmblemHealth Lab Benefit Program (LBM) members.
Removed "Non-vaginal Candida species" and associated codes from the table, as the codes for all Candida species are the same and appropriate ordering scenarios for NAAT testing for Candida are addressed in M2057 and M2172.
Direct probe testing for Chlamydia pneumoniae, Cytomegalovirus, Legionella pneumophila, and Mycoplasma pneumoniae all changed (management in coverage criteria updated).
Microorganism 'Mycoplasma genitalium' (Amplified Probe CPT code 87563) removed from Table 1.
Herpes virus-6 (Direct Probe CPT code 87531) changed from Meets Coverage Criteria to Does Not Meet Coverage Criteria.
Simultaneous ordering of amplified probe and quantification for the same organism in a single encounter DOES NOT MEET coverage.
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.