Concert Lab Infectious Disease Lab Screening and Testing
Date: 04/21/25
Iowa Total Care will implement new payment policies related to infectious diseases. These payment policies provide payment protocols for primary and preventive care lab screenings and testing.
The following infectious disease payment policies will be implemented on August 1, 2025:
| Policy Name | Policy Description |
|---|---|
Respiratory Lab Testing | This policy outlines criteria for syndromic/multiplex respiratory panels with 6 or more targets, SARS-CoV-2, RSV, or influenza A/B. OR multiplex respiratory viral panels with 5 or fewer targets, bacterial respiratory infection/pneumonia panels, influenza A and B antibody tests, Group A Streptococcus pharyngitis tests, Group A Streptococcus pharyngitis cultures and Group A Streptococcus antibody tests. |
| Multi-System Lab Testing CG.CP.MP.02 | This policy outlines the appropriate use of tests for pathogens that can cause multi-system 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. |
| Dermatologic Testing CG.CP.MP.03 | This policy outlines the appropriate use of microscopy/peroxidase tests, fungal culture and culture-independent molecular tests (NAAT/PCR) for onychomycosis. |
| Gastroenterologic Lab Testing CG.CP.MP.04 | This policy outlines appropriate use of multi pathogen panels, as well as diagnostic assays targeted at Helicobacter pylori (H. pylori). |
| Primary Care and Preventive Lab Screening CG.CP.MP.05 | This policy outlines criteria for human papillomavirus (HPV), hepatitis C virus (HCV) and group B streptococcus (GBS). |
| Vector-Borne and Tropical Diseases Lab Testing CG.CP.MP.06 | This policy outlines criteria for Lyme disease and Zika virus testing via serologic and molecular methods. |
| Genitourinary Lab Testing CG.CP.MP.07 | This policy outlines criteria for targeted vaginitis/vaginosis pathogen testing, expanded multiplex vaginitis/vaginosis pathogen panels, urine culture for asymptomatic bacteriuria and molecular/multiplex urinary tract infection panels. |
For questions or concerns, contact your provider engagement account manager in your area or call Provider Services at 1-833-404-1061, Monday – Friday 7:30 a.m. to 6 p.m. CT.