Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease
Coverage policy for serum biomarker and multianalyte assays used to evaluate and monitor hepatic fibrosis in chronic liver disease; governs medical necessity determinations for members of Medical Mutual - Ohio.
Policy lists specific assays that meet coverage criteria for HBV/HCV and for MASLD/MASH or alcoholic hepatitis (FibroSURE®, ELF™, FibroTest®) with six-month frequency.
Other multianalyte assays with algorithmic analysis (examples: ASH FibroSURE®, LIVERFASt™, NASH FibroSURE®, OWLiver®) are explicitly not covered.
A long list of individual serum biomarkers (e.g., miRNAs, CHI3L1, hyaluronic acid, Type III/IV procollagen, laminin, CK-18, MFAP4) are listed as not meeting coverage criteria except when part of an allowed panel.
CC1 revised to allow FibroSURE (HBV/HCV), ELF, or FibroTest once every six months for chronic HBV or HCV; CC2 revised to allow ELF or FibroTest once every six months for MASLD/MASH/alcoholic hepatitis and to rule out cACLD with elevated LSM.
Removed CPT codes 88341 and 88342 (listed in revision history).
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.