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Effective July 1, 2024 Coverage criteria for Concert Genetic Testing and Concert Lab Testing

Date: 05/01/24

Louisiana Healthcare Connections presents new clinical payment policies to provide payment protocols for Infectious Disease Primary and Preventive Care Lab Screenings and Lab Testing related to Infectious Diseases.

All providers billing for laboratory services must bill according to the Centers for Medicare & Medicaid Services (CMS), National Correct Coding Initiative (NCCI), and the American Medical Association (AMA).

The following policies will be effective July 1, 2024 and can be found on our  Provider website for future reference.

PolicyPolicy OverviewEffective Date
LA.CP.CG.27
Infectious Disease: Respiratory Lab Testing		Diagnostic testing for upper respiratory tract infections can be very useful for clinicians, as clinical signs and symptoms of these infections can have significant overlap between pathogens. Accurate and rapid testing techniques may aid clinicians, via identification of a specific pathogen, in selecting the best course of treatment for patients. Optimally, treatment is started within 48-72 hours of
diagnosis		July 1, 2024
LA.CP.CG.28                 
Infectious Disease: Multisystem Lab Testing   		This policy outlines the appropriate use of tests for pathogens that can cause multisystem symptoms and/or infections. Tests for pathogens that infect multiple body systems can be targeted to detect a specific pathogen(s) or non-targeted to broadly detect nucleic acid from any potential pathogen.  
LA.CP.CG.29
nfectious Disease:  Dermatologic Lab Testing		Confirmatory testing should be performed to confirm fungal infection before initiating treatment to prevent inappropriate use of antifungal medications. Available testing methods include microscopy, culture, and molecular (PCR-based) techniques. 
LA.CP.CG.30                 
Infectious Disease: Gastroenterologic Lab Testing   		Infections of the gastrointestinal (GI) tract represent a significant cause of infectious disease worldwide. GI infections can be caused by several pathogen types, including bacteria, viruses, fungi, and parasites (e.g., protozoal illnesses such as giardiasis). This document outlines several common types of GI pathogen tests
and guideline or peer-reviewed literature-supported criteria for their appropriate applications. 		 
LA.CP.CG.32                    Infectious Disease: Primary Care & Preventive Lab Screening  In some instances, testing of healthy/asymptomatic individuals for infectious diseases is recommended as part of public health prevention and minimization of harm efforts. This policy outlines criteria
for human papillomavirus (HPV), hepatitis C virus (HCV), and group B streptococcus (GBS).

 
LA.CP.CG.31
Infectious Disease: Vector-Borne and
Tropical Diseases Lab Testing   		Vector-borne diseases are caused by bacteria, viruses, and parasites that are transmitted by other living organisms to humans.
This policy outlines criteria for Lyme disease and Zika virus testing via serologic and molecular methods		 
LA.CP.CG.33
Infectious Disease: Genitourinary
Lab Testing   		Testing urine and genital secretions may enable providers to choose precise therapy and afford the patient a better outcome. Cultures, microscopic examination and molecular identification are all common testing methods for evaluating the infectious causes of various genitourinary conditions. 

Thank you for your support and continued partnership on providing our members with access to high-quality health care at an affordable price. If providers have questions, please contact your provider network representative, or call 1-866-595-8133.