Medical Policy Update for February 26, 2025

Medical Guidelines	Reason for Update
Biochemical Markers of Alzheimer Disease and Dementia AHS - G2048	Deleted code 0346U to Billing/Coding section.
Biomarker Testing for Autoimmune Rheumatic Disease AHS - G2022	Updated Billing/Coding section to remove PLA code 0456U, effective 1/1/2025.
Diagnosis of Idiopathic Environmental Intolerance AHS - G2056	Reviewed by Avalon 4th Quarter 2024 CAB. Description, Policy Guidelines and References updated. No change to policy statement. Medical Director review 1/2025
Diagnostic Testing of Sexually Transmitted Infections AHS - G2157	Added the following code to the Billing/Coding section: 87626.
Genetic Testing for Lipoprotein A Variant(s) as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment AHS – M2082	Reviewed by Avalon 4th Quarter 2024 CAB. Description, Policy Guidelines, and References updated. No change to policy statement. Medical Director review 1/2025.
Genetic Testing for Rett Syndrome AHS – M2088	Reviewed by Avalon 4th Quarter 2024 CAB. Description, Policy Guidelines and References sections updated. No change to policy statement. Medical Director review 1/2025
Immune Cell Function Assay for Organ Transplant Rejection AHS - G2098	Reviewed by Avalon 4th Quarter 2024 CAB. Medical Director review 12/2024. Updated policy guidelines and added references. No change to policy statement.
Immunohistochemistry AHS – P2018	Reviewed by Avalon 4th Quarter 2024 CAB. Medical Director Review 1/2025. Policy Guidelines and References updates. No change to policy statement.
Oral Cancer Screening and Testing AHS - G2113	Updated Billing/Coding section to add CPT code 87626, effective 1/1/2025.
Pancreatic Cancer Risk Testing Using Pancreatic Cyst Fluid AHS - M2114	Reviewed by Avalon 4th Quarter 2024 CAB. Medical Director review 12/2024. Updated description, policy guidelines, and guideline recommendations. Added references. No change to policy statement.
Pathogen Panel Testing AHS - G2149	Reviewed by Avalon 4th Quarter CAB 2024 for code updates only. Added codes 0202U, 0223U and 0225U to Billing/Coding section.
Pharmacogenetics Testing AHS - M2021	Reviewed by Avalon 4th Quarter 2024 CAB for code updates only. Code 0380U deleted from Billing/Coding section, effective 1/1/25.
Prenatal Testing for Fetal Aneuploidy AHS - G2055	Reviewed by Avalon 4th Quarter 2024 CAB. Description, related policies, policy guidelines, and references updated. No change to policy statement. Medical Director review 1/2025.
Professional Pathology Billing Requirements AHS – R2169	Removed reimbursement disclaimer and added medical policy disclaimer information. No change to policy statement.
Testing for 5-Fluorouracil Use in Cancer Patients AHS - M2067	Reviewed by Avalon 4th Quarter 2024 CAB. Medical Director review 12/2024. Updated policy guidelines and references. No change to policy statement.
Testing for Vector-Borne Infections AHS – G2158	Added the following codes to the Billing/Coding section: 87164 and 87166.
Testosterone AHS – G2013	Reviewed by Avalon 4th Quarter 2024 CAB. Policy Guidelines and References updated. No changes to coverage criteria. Medical Director review 12/2024

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