In addition, testing required for employment, school or recreational activities is not considered medically necessary treatment of disease. Note: Standard benefit plans exclude coverage of testing required for work, school, or recreational activities. Coronavirus COVID-19, for indications consistent with CDC Guidance related to COVID-19.Colorectal cancer, hereditary non-polyposis colorectal cancer (MLH1, MSH2, MSH6 and microsatellite instability) and familial adenomatous polyposis (FAP, APC), for persons who meet criteria in CPB 0140 - Genetic Testing.Colorado tick fever virus, for diagnosis of Colorado tick fever within the first 14 days, before serologic tests become positive.Clostridium difficile, diagnosis (e.g., persons with diarrhea, not for asymptomatic or 'test of cure').Chromosome 18q assay for persons with colorectal cancer.Chlamydia trachomatis, for screening Footnote1* and diagnosis for persons who meet criteria in CPB 0433 - Chlamydia Trachomatis - Screening and Diagnosis.Chlamydophila ( Chlamydia) pneumoniae, in members with signs or symptoms suggestive of Chlamydial pneumonia.Chancroid ( Haemophilus ducreyi), for diagnosis of persons with genital ulcer disease.Candidiasis ( Candida albicans, glabrata, krusei, parapsilosis and tropicalis) for diagnosis of symptomatic vaginitis (see CPB 0643 - Diagnosis of Vaginitis).

Brucella spp., for members with signs and symptoms of Brucellosis, and history of direct contact with infected animals and their carcasses or secretions or by ingesting unpasteurized milk or milk products.

Breast and ovarian cancer (BRCA1, BRCA2), for persons who meet criteria for BRCA testing (see CPB 0227 - Breast and Ovarian Cancer Susceptibility Gene Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy).BRAF mutation analysis for hairy cell leukemia.Apnea (with or without cyanosis) (for infants less than 1 year of age only).Coughing with documented exposure to pertussis or.parapertussis, for diagnosis of whooping cough in individuals with 1 of the following that has occurred in less than 21 days (or 3 weeks): BK polyomavirus in transplant recipients receiving immunosuppressive therapies and persons with immunosuppressive diseases (e.g., immune complex glomerulonephritis associated with HIV/AIDS).Beta-tyrosinase, to detect hematogenous spread of melanoma cells in members with melanoma.miyamotoi infection in persons from endemic areas with signs of symptoms suggesting these infections Borrelia miyamotoi infection, diagnosis in acute phase of B.quintana infection in HIV-infected members and other immunocompromised members with signs and symptoms of bacillary angiomatosis or peliosis hepatitis (see also CPB 0215 - Lyme Disease and Other Tick-Borne Diseases) elizabethae ), to confirm diagnosis in acutely or severely ill members with systemic symptoms of Cat-Scratch Disease, particularly persons with hepatosplenomegaly or persons with large painful adenopathy and immunocompromised hosts and to distinguish B. curtisii, megasphaera type 1 and type 2) for the diagnosis in symptomatic vaginitis (see CPB 0643 - Diagnosis of Vaginitis) Bacterial vaginosis ( Gardnerella vaginalis, Atopobium vaginae, Mobiluncus mulieris, M.Ongoing listings of countries affected by avian influenza are available from the World Organization for Animal Health, available at OIE - World Organization for Animal Health A history of travel to or contact with persons or birds from a country with documented H5N1 avian influenza infections within 10 days of symptom onset.

Symptoms consistent with Avian influenza A virus (see background) and.Avian influenza A virus, for diagnosis of avian influenza A (H5N1) in persons with both:.Anaplastic lymphoma kinase (ALK) testing as an alternative to FISH for selecting individuals for ALK inhibitor therapy.Adenovirus, to diagnose adenovirus myocarditis, and to diagnose adenovirus infection in immunocompromised hosts, including transplant recipients.Actinomyces, for identification of actinomyces species in tissue specimens.Qualitative Polymerase Chain Reaction (PCR) TestingĪetna considers the following qualitative polymerase chain reaction (PCR) testing medically necessary (not an all-inclusive list):.This Clinical Policy Bulletin addresses qualitative and quantitative polymerase chain reaction (PCR) testing. Number: 0650 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References

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