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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-157 ESRD Oral-Only Renal Dialysis Services – Drugs & Biologicals

Effective January 1, 2025, in accordance with CMS updates to the ESRD Prospective Payment System (PPS), oral-only renal dialysis service drugs and biologicals, specifically phosphate binders, will be incorporated into the ESRD PPS bundled payment model.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-144 Advanced Primary Care Management (APCM) Services

This reimbursement policy outlines the guidelines and procedures for billing and reimbursement of Advanced Primary Care Management (APCM) services, including newly added Behavioral Health Integration (BHI) and Collaborative Care Model (CoCM) services.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-068 Prenatal Screening (Nongenetic)

Prenatal screening encompasses any testing done to determine the health status of the pregnant individual and/or fetus.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-064 Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

To manage loss of response due to the development of anti-drug antibodies, immunopharmacologic monitoring of circulating drug and anti-drug antibody levels has been proposed.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-061 Serum Biomarker Testing for Multiple Sclerosis and Related Neurological Diseases

Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system (CNS) and is defined by multifocal areas of demyelination with loss of oligodendrocytes and astroglial scarring.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-058 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a class of inflammatory bowel disorders comprised of two major disorders: ulcerative colitis and Crohn’s disease each with distinct pathologic and clinical characteristics.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-057 Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease

Chronic liver disease (CLD) refers to a wide range of liver pathologies that include inflammation (chronic hepatitis), liver cirrhosis, and hepatocellular carcinoma.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-056 Gamma-glutamyl Transferase Testing in Adults

Gamma-glutamyl transferase (GGT), also known as gamma-glutamyl transpeptidase (GGTP),1,2 is an enzyme that has a half-life of between fourteen and twenty-six days and is present in the cell membrane of many different tissue types, including the heart, brain, seminal vesicles, kidneys, bile duct, spleen, and gallbladder

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-053 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

Intestinal dysbiosis is defined as a disruption or imbalance of the intestinal microbial ecology.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-051 Celiac Disease Testing

Celiac disease is a hereditary, chronic autoimmune disorder that affects one in 100 individuals worldwide.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-049 Metabolite Markers of Thiopurines Testing

Thiopurines are a class of purine antimetabolite immunomodulators with diverse clinical applications in treatment of autoimmune disorders, transplant rejection, and acute lymphoblastic leukemia.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-048 Testing for Alpha-1 Antitrypsin

Alpha 1-antitrypsin deficiency (AATD) is a genetic disease that causes deficient or defective production of the alpha-1 antitrypsin (AAT) protease inhibitor that can affect the lungs, liver, and rarely skin.

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Reimbursement Policy
  
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