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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-020 Onychomycosis Testing

Onychomycosis, also known as tinea unguium (Wollina et al., 2016), is a fungal infection of the nail typically caused by pathogenic fungal dermatophytes, such as Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccossum; onychomycosis may also be caused by yeasts, including Candida parapsilosis and Candida guilliermondii, or non-dermatophyte molds, including Neoscytalidium dimidiatum, Onychocola canadensis, the Aspergillus species, Scopulariopsis species, Alternaria species, Acremonium species, and Fusarium species (Ameen et al., 2014; Bongomin et al., 2018; Wollina et al., 2016).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-025 Pediatric Preventive Screening

Preventive screening is a healthcare service with the goal of illness prevention and health management.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-026 Prostate Specific Antigen (PSA) Testing

Prostate-specific antigen (PSA) is a glycoprotein that is produced by both normal and neoplastic prostate tissue.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-018 Diagnosis of Vaginitis

Vaginitis is defined as inflammation of the vagina with symptoms of discharge, itching, and discomfort often due to a disruption of the vaginal microflora.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-029 Testosterone Testing

Testosterone is a naturally occurring lipophilic androgen hormone that is produced by both males and females for various functions.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-037 Urinary Tumor Markers for Bladder Cancer

Bladder cancer is defined as a malignancy that develops from the tissues of the bladder. It is the most common cancer of the urinary system.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-038 Immunohistochemistry

Immunohistochemistry (IHC) is a very sensitive and specific staining technique that uses anatomical, biochemical, and immunological methods to identify cells, tissues, and organisms by the interaction of target antigens with highly specific monoclonal antibodies and visualization though the use of a biochemical tag or label (Fitzgibbons et al., 2014).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-052 Helicobacter pylori Testing

Helicobacter pylori (H. pylori) is a spiral-shaped, gram-negative bacteria that thrives while living in acidic environments, growing in close association with the stomach lining.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-059 Allergen Testing

Allergic disease is characterized by inappropriate or exaggerated rated immune reactions to foreign antigens (allergens) that are generally innocuous to most people, but when introduced into a genetically-predisposed individual, elicit a hypersensitivity reaction (Hamilton, 2023).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-067 Evaluation of Dry Eyes

Dry eye disease (dysfunctional tear syndrome, DED) is defined by the Dry Eye Workshop II as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles” (Craig, Nichols, et al., 2017).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-003v2 Folate Testing

Folate, or vitamin B9, is a generic term for a water-soluble vitamin obtained from the diet that is involved in the transfer of methyl groups (i.e., single carbon-containing groups) in multiple biochemical metabolic pathways, including nucleic acid biosynthesis and methionine/homocysteine metabolism.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-012v3 Pathogen Panel Testing

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.

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