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Infectious diseases can be caused by a wide range of pathogens. Conventional diagnostic methods like culture, microscopy with or without stains and immunofluorescence, and immunoassay often lack sensitivity and specificity and have long turnaround times. Panels for pathogens using multiplex amplified probe techniques and multiplex reverse transcription can detect and identify multiple pathogens in one test using a single sample.
Molecular panel tests for infectious diseases have changed the landscape of clinical microbiology. They play an important role in diagnostic testing, as they simultaneously detect several different pathogens associated with similar and overlapping clinical symptomatology. For this reason, they are also known as 'syndromic panel' tests. These panels belong to a category of testing known as culture-independent diagnostic tests (CIDTs), which are tests that detect pathogens without the need to grow and isolate them in culture. These tests have shorter turnaround times, often have good test performance characteristics, and require limited technical expertise, making them appealing for use by clinicians as well as clinical laboratories.
Historically, physicians were required to select the specific pathogens most likely thought to be associated with a patient’s disease. They often had to rely on empiric therapy until results from the laboratory could be used in identifying definitive or targeted antimicrobial therapy, with results taking days and sometimes weeks. In recent years, molecular panel tests, including multiplex polymerase chain reaction (PCR), have become increasingly used for the detection of pathogens, and clinicians are no longer required to name (or separately test for) many of the bacterial, viral, fungal, and parasitic species sought for a given clinical ‘syndrome'. As the use of multiplex molecular tests have decreased the need to perform multiple assays to diagnose a given infection, results are often available to the physician within minutes to hours. Though culture-based methods of diagnosis are still routinely utilized, and definitive antimicrobial therapy may still lag pending full culture and susceptibility information, these tests have revolutionized infectious disease diagnostics and have made the road from diagnosis to treatment very rapid, in some cases occurring at the point-of-care (POC).
Finally, some of these multiplex panels are smaller, or ‘targeted', detecting just a few pathogens whereas others are very large, detecting approximately 20 targets. The larger panels are sometimes referred to as ‘expanded'. Many commercial platforms for multiplex panel testing have been developed for a variety of infection types in different organ systems. Both smaller and larger panels are being used in clinical laboratories, though their optimal use and application in various settings and for various patient populations and indications, remain a challenge.
Testing must be performed according to Clinical Laboratory Improvement Amendments (CLIA) and/or FDA regulations. For example, CLIA-non-waived tests may only be performed in certified laboratories and according to CLIA regulations. CLIA-waived tests may be performed in healthcare settings that operate under a CLIA Certificate of Waiver or Certificate of Compliance/Certificate of Accreditation.
Related Medical Policies -
Multitarget Polymerase Chain Reaction Testing for Diagnosis of Bacterial Vaginosis
Intravenous Antibiotic Therapy and Associated Diagnostic Testing for Lyme Disease
Coronavirus Disease 2019 (COVID-19) Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Testing
Antigen Testing for Rapid Detection of Coronavirus Disease 2019 (COVID-19)
General Approach to Pathogen Panel Testing
Molecular syndromic infectious disease pathogen identification panel testing may be considered medically necessary when ALL of the following criteria are met and clearly stated in the medical record:
The individual has a clinical indication for infectious disease testing as outlined in the Panel-Specific Testing Guidelines section below (i.e., clinical suspicion of a pathogen as the cause of the patient’s condition), AND
It is clearly documented why an evaluation for more than one (1) pathogen by molecular testing is necessary for patient management, AND
The results of testing will impact clinical management in a manner already demonstrated in the peer-reviewed published literature to improve patient outcomes, AND
The testing is performed according to the intended use of the test in the intended patient population for which the test was developed and validated.
Panel-Specific Testing Guidelines
Respiratory Pathogen Panel
The use of respiratory pathogen panel nucleic acid testing (without quantification of viral load) (87631) may be considered medically necessary when ALL of the following criteria are met:
Multiplex PCR-based panel is limited to up to five (5) respiratory pathogens, AND
Patient is displaying signs and symptoms of a respiratory tract infection, as evidenced by a compatible clinical syndrome (elevated temperature, dyspnea, tachypnea or tachycardia), AND
Results of the testing will be used to guide or alter management.
Multiplex PCR respiratory panels are considered investigational when all of the above criteria are not met.
Gastrointestinal Pathogen Panel
Multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens of up to 5 targets (87505) may be considered medically necessary when performed as part of an evaluation for an individual with any of the following:
Diarrhea for more than seven (7) days with any of the following:
Fever
Bloody or mucoid stools
Severe abdominal cramping or tenderness
Signs of sepsis
Suspected enteric fever (i.e., typhoid or paratyphoid) in an individual with a history of recent travel to an endemic region (e.g., south-central Asia, Southeast Asia, and southern Africa) or who has consumed foods prepared by people with recent endemic exposure
Multiplex PCR gastrointestinal panels are considered investigational when all of the above criteria are not met.
Sexually Transmitted Infection (STI) Panel
Molecular detection-based panel testing for vaginitis and/or sexually transmitted infections is considered not medically necessary (ex. or T. E. N. Sexually Transmitted Infection Panel). Services covered under preventive wellness benefits are addressed in the following medical policies:
Urine Tract Infection Pathogen Panel
Molecular detection-based panel testing of urine pathogens for the diagnosis of urinary tract infections, is considered not medically necessary (ex. such as the T.E.N. Urinary Tract Infection Panel).
Wound Pathogen Panel
Molecular-based panel testing to screen for or diagnose wound infections (i.e. skin/soft tissue infections), including diagnostic testing to confirm biofilm presence is considered not medically necessary (ex. Proteus Genomics WOUND-PRO or Nail-Pro).
Wellness Panel
Wellness panel testing is considered not medically necessary. Services covered under preventive wellness benefits are addressed in the following medical policies:
Other Molecular-Based Panel Testing
All other molecular-based panel testing for general screening or detection of microorganisms is considered not medically necessary. Testing includes, but is not limited to the following:
Molecular-based panel testing on stool samples, such as SmartGut™
Molecular-based panel testing on vaginal swabs, such as SmartJane™
Molecular-based panel testing on urine samples, such as UroSwab®
Antibiotic resistance panels including, but may not be limited to:
ABRx Antibiotic Resistance Panel
RevoGene Carba C
XPERT Carba-R
Multiplex PCR-based panel testing of pathogens in cerebrospinal fluid (CSF)
Molecular-based panel testing of bloodstream pathogens
Molecular-based panel testing on nail clipping(s) to screen, diagnose, or confirm onychomycosis
Combination pathogen identification and antibiotic resistance or sensitivity panels including, but may not be limited to:
Bridge Urinary Tract Infection Detection and Resistance Test
Guidance UTI
Proteus UTI-Pro
Central nervous system pathogen panel
Molecular syndromic infectious disease pathogen identification panel testing is not medically necessary if the patient has been previously tested by molecular diagnostic methods for the same pathogens within 14 days for the same clinical indication.
Federal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Mental Health Disorders, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of medical necessity, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
01/15/2024: New policy added. Approved by the Medical Policy Advisory Committee. Effective 02/15/2024.
02/15/2024: Code Reference section updated to add ICD-10 diagnosis codes A01.00 - A01.09, A01.1 - A01.4, A04.1, A04.8, A04.9, A08.4, A09, R19.7, Z20.01, and Z20.09 to the medically necessary gastrointestinal pathogen panel codes table. Corrected the code descriptions for CPT codes 87651 and 87653.
10/01/2024: Code Reference section updated to add new CPT codes 0504U and 0505U.
12/19/2024: Code Reference section updated to add new CPT code 0528U effective 01/01/2025.
03/27/2025: Policy reviewed; no changes.
04/01/2025: Code Reference section updated to add new CPT code 0531U, effective 04/01/2025.
07/18/2025: Code Reference section updated to add new CPT codes 0556U, 0563U, and 0564U. Effective 07/01/2025.
10/01/2025: Code Reference section updated to add new CPT codes 0590U, 0593U, and 0595U.
01/01/2026: Code Reference section updated to add new CPT codes 0600U, 0601U, and 87627.
BlueCross BlueShield of North Carolina. Pathogen Panel Testing. Accessed Jan. 2023.
BlueCross BlueShield of North Carolina. Onychomycosis Testing. Accessed June 2023.
MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing.
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39001&ver=8& .
Accessed Jan. 2023.
This may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
Medically Necessary Codes
Gastrointestinal Pathogen Panel
Code Number | Description |
CPT-4 | |
87505 | Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis | |
A01.00 - A01.09 | Typhoid fever |
A01.1 - A01.4 | Parathyroid fever |
A04.1 | Enterotoxigenic Escherichia coli infection |
A04.8 | Other specified bacterial intestinal infections |
A04.9 | Bacterial intestinal infection, unspecified |
A08.4 | Viral intestinal infection, unspecified |
A09 | Infectious gastroenteritis and colitis, unspecified |
R19.7 | Diarrhea, unspecified |
Z20.01 | Contact with and (suspected) exposure to intestinal infectious diseases due to Escherichia coli (E. coli) |
Z20.09 | Contact with and (suspected) exposure to other intestinal infectious diseases |
Respiratory Pathogen Panel
Code Number | Description |
CPT-4 | |
0240U | Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected (Deleted 06/30/2025) |
0241U | Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected (Deleted 06/30/2025) |
87631 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
Not Medically Necessary Codes
Gastrointestinal Pathogen Panel
Code Number | Description |
CPT-4 | |
0369U | Infectious agent detection by nucleic acid (DNA and RNA), gastrointestinal pathogens, 31 bacterial, viral, and parasitic organisms and identification of 21 associated antibiotic-resistance genes, multiplex amplified probe technique (Deleted 06/30/2025) |
86723 | Antibody; Listeria Monocytogenes |
86759 | Antibody; Rotavirus |
87481 | Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique |
87500 | Infectious agent detection by nucleic acid (DNA or RNA); Vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique |
87506 | Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets |
87507 | Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, clostridium difficile, e. Coli, salmonella, shigella, norovirus, giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets |
87640 | Staphylococcus Aureus, amplified probe technique |
87653 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique |
87798 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
Respiratory Pathogen Panel
Code Number | Description |
CPT-4 | |
0115U | Respiratory infectious agent detection by nucleic acid (DNA and RNA), 18 viral types and subtypes and 2 bacterial targets, amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected |
0202U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected |
0223U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected) |
0225U | Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected |
0373U | Infectious agent detection by nucleic acid (DNA and RNA), respiratory tract infection, 17 bacteria, 8 fungus, 13 virus, and 16 antibiotic-resistance genes, multiplex amplified probe technique, upper or lower respiratory specimen (Deleted 06/30/2025) |
0528U | Lower respiratory tract infectious agent detection, 18 bacteria, 8 viruses, and 7 antimicrobial resistance genes, amplified probe technique, including reverse transcription for RNA targets, each analyte reported as detected or not detected with semiquantitative results for 15 bacteria (New 01/01/2025) |
0556U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific DNA and RNA by real-time PCR, 12 targets, nasopharyngeal or oropharyngeal swab, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected (New 07/01/2025) |
0563U | Infectious disease (bacterial and/or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 11 viral targets and 4 bacterial targets, qualitative RT-PCR, upper respiratory specimen, each pathogen reported as positive or negative (New 07/01/2025) |
0564U | Infectious disease (bacterial and/or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 10 viral targets and 4 bacterial targets, qualitative RT-PCR, upper respiratory specimen, each pathogen reported as positive or negative (New 07/01/2025) |
87481 | Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique |
87486 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique |
87500 | Infectious agent detection by nucleic acid (DNA or RNA); Vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique |
87541 | Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique |
87561 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique |
87581 | Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique |
87632 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets |
87633 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets |
87640 | Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique |
87651 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique |
87653 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique |
87798 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
Sexually Transmitted Infection Panel
Code Number | Description |
CPT-4 | |
87491 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique |
87529 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique |
87591 | Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhea, amplified probe technique |
87625 | Infectious agent detection by nucleic acid (DNA or RNA); Human papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed |
87661 | Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique |
87798 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
Urine Tract Infection Pathogen Panel
Code Number | Description |
CPT-4 | |
0371U | Infectious agent detection by nucleic acid (DNA or RNA), genitourinary pathogen, semiquantitative identification, DNA from 16 bacterial organisms and 1 fungal organism, multiplex amplified probe technique via quantitative polymerase chain reaction (qPCR), urine |
0372U | Infectious disease (genitourinary pathogens), antibiotic-resistance gene detection, multiplex amplified probe technique, urine, reported as an antimicrobial stewardship risk score |
0374U | Infectious agent detection by nucleic acid (DNA or RNA), genitourinary pathogens, identification of 21 bacterial and fungal organisms and identification of 21 associated antibiotic-resistance genes, multiplex amplified probe technique, urine (Deleted 06/30/2025) |
0504U | Infectious disease (urinary tract infection), identification of 17 pathologic organisms, urine, real-time PCR, reported as positive or negative for each organism |
0590U | Infectious disease (bacterial and fungal), DNA of 44 organisms (34 bacteria, 10 fungi), urine, next-generation sequencing, reported as positive or negative for each organism (New 10/01/2025) |
0593U | Infectious disease (genitourinary pathogens), DNA, 46 targets (28 pathogens, 18 resistance genes), RT-PCR amplified probe technique, urine, each analyte reported as detected or not detected (New 10/01/2025) |
81003 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy |
87481 | Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique |
87500 | Infectious agent detection by nucleic acid (DNA or RNA); Vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique |
87511 | Infectious agent detection by nucleic acid (DNA or RNA); gardnerella vaginalis, amplified probe technique |
87556 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, amplified probe technique |
87561 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique |
87563 | Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma genitalium, amplified probe technique |
87640 | Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique |
87641 | Staphylococcus aureus, methicillin resistant, amplified probe technique |
87653 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique |
87798 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
Wellness Panel
Code Number | Description |
CPT-4 | |
80050 | General health panel this panel must include the following: comprehensive metabolic panel (80053) blood count, complete (cbc), automated (85027) and appropriate manual differential wbc count (85007 or 85009) thyroid stimulating hormone (tsh)(84443). |
80061 | Lipid panel this panel must include the following: cholesterol, serum, total (82465) lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) |
82150 | Amylase |
82248 | Bilirubin; Direct |
82306 | Calcifediol (25-OH vitamin D-3) |
82533 | Cortisol; Total |
82607 | Cyanocobalamin (Vitamin B-12) |
82627 | Dehydroepiandrosterone-Sulfate (DHEA-S) |
82670 | Estradiol; Total |
82728 | Ferritin |
82746 | Folic acid; Serum |
82977 | Glutamyltransferase, Gamma (GGT) |
83002 | Gonadotropin; Luteinizing Hormone (LH) |
83003 | Growth Hormone, Human (HGH) (Somatotropin) |
83036 | Hemoglobin; Glycosylated (A1C) |
83525 | Insulin; Total |
83540 | Iron |
83615 | Lactate Dehydrogenase (Ld), (Ldh); |
83735 | Magnesium |
84100 | Phosphorus Inorganic (Phosphate); |
84144 | Progesterone |
84146 | Prolactin |
84153 | Prostate specific antigen (PSA); total |
84154 | Prostate Specific Antigen (PSA); Free |
84270 | Sex hormone binding globulin (SHBG) |
84403 | Testosterone; Total |
84439 | Thyroxine; Free |
84466 | Transferrin |
84481 | Triiodothyronine T3; Free |
84550 | Uric acid; Blood |
86140 | C-Reactive Protein |
86431 | Rheumatoid Factor; Quantitative |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
Wound Care Pathogen Panel
Code Number | Description |
CPT-4 | |
0370U | Infectious agent detection by nucleic acid (DNA and RNA), surgical wound pathogens, 34 microorganisms and identification of 21 associated antibiotic-resistance genes, multiplex amplified probe technique, wound swab (Deleted 06/30/2025) |
87481 | Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique (5 units) |
87500 | Infectious agent detection by nucleic acid (DNA or RNA); Vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique |
87640 | Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique |
87651 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique |
87653 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique |
87798 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism (13 units) |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
Other Molecular-Based Panel Testing
Code Number | Description |
CPT-4 | |
0505U | Infectious disease (vaginal infection), identification of 32 pathogenic organisms, swab, real-time PCR, reported as positive or negative for each organism |
0531U | Infectious disease (acid-fast bacteria and invasive fungi), DNA (673 organisms), next-generation sequencing, plasma (New 04/01/2025) |
0595U | Infectious disease (tropical fever pathogens), vector-borne and zoonotic pathogens, including 2 viruses (Chikungunya virus and Dengue virus serotypes 1, 2, 3, and 4), 1 bacterium (Leptospira species), and 1 parasite with species differentiation (Plasmodium species, Plasmodium falciparum, and Plasmodium vivax/ovale), real-time RT-PCR, whole blood, each pathogen reported as detected or not detected (New 10/01/2025) |
0600U | Infectious disease (wound infection), identification of 65 organisms and 30 antibiotic resistance genes, wound swab, real-time PCR, reported as positive or negative for each organism (New 01/01/2026) |
0601U | Infectious disease (periprosthetic joint infection), analysis of 11 biomarkers (alpha defensins 1–3, C reactive protein, microbial antigens for Staphylococcus [SPA, SPB], Enterococcus, Candida, and C. acnes, total nucleated cell count, percent neutrophils, RBC count, and absorbance at 280 nm) using immunoassays, hematology, clinical chemistry, synovial fluid, and diagnostic algorithm reported as a probability score (New 01/01/2026) |
87483 | Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (eg, Neisseria meningitidis, Streptococcus pneumoniae, listeria Haemophilus influenzae, E.coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster virus, Cryptococcus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets |
87627 | Infectious agent detection by nucleic acid (DNA or RNA); joint space pathogens and drug resistance genes, multiplex amplified probe technique, 26 or more targets (New 01/01/2026) |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
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