AMA Targets vs MOLDX "Syndromic Pathogen Panels"

 Subject: RE: [EXTERNAL] Super quick question about Infectious Disease Tech Asssmt

Good afternoon,

 

Molecular (DNA/RNA) syndromic panels (‘panel’ as defined in the policy is a test that detects > 1 pathogen) for infectious disease pathogen identification testing are the tests within scope of this policy.  A 'syndromic panel' is further defined as one that simultaneously detects multiple different pathogens associated with similar and overlapping clinical symptomatology.

Therefore, if a molecular test detects multiple types or strains of one common pathogen – ie the test detects 

• only Influenza (even if it detects both Influenza A and B), 
• only Herpes Simplex Virus (even if it detects both HSV-1 and -2), or 
• only Human Immunodeficiency Virus (even if it detects both HIV-1 and HIV-2) - 

then the test is not within scope of the policy, as it is not a syndromic panel.

Note that the syndromic test panel is a single test with multiple components and is characterized by a single unit of service.  A syndromic panel cannot be unbundled and billed as individual components regardless of the fact that the test reports multiple individual pathogens and/or targets.

 

Thank you,

 

MolDX

When do you have to submit a TA, rather than just submit the CPT code?

Does this TA apply to panels of 2-5 as well as panels of 6 or more?