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Geisinger Health Plan is revising coverage policy for large multiplex respiratory pathogen panels. This change is effective Wednesday, April 1.

After a thorough evaluation we’ve determined this change will allow us to more accurately balance member benefits with the cost of services.

Coverage policy details

  • The policy change affects CPT code 0202U a proprietary laboratory analysis (PLA) code for the BioFire® FilmArray® Respiratory Panel 2.1 (RP2.1). This test is a qualitative, real-time polymerase chain reaction (RT-PCR) assay that detects 22 bacterial and viral respiratory pathogens, including SARS-CoV-2 (the virus that causes COVID-19), from a single nasopharyngeal swab.
  • The policy change is specific to testing in the outpatient and emergency care settings. Coverage criteria do not apply to testing allowances in situations other than the outpatient and emergency care settings.
  • RP2.1 will only be considered medically necessary for patients in observation and inpatient status.
  • The coverage criteria applies to all plans, including Geisinger Gold and GHP Family (Medicaid).

Unexpected costs to members

Members who see their healthcare provider for a respiratory illness may end up paying a lot for what they thought was a simple test. Depending on their benefit structure, some are finding they owe way more than they expected.

Respiratory panels are often necessary — and even requested by patients who think they may have the flu or COVID. But patients should understand broadly that there are associated costs, even for seemingly simple swabs, so they can make informed decisions.

When you offer respiratory testing options to your patients, be sure to remind them that testing could have a significant impact on their deductible and out-of-pocket costs.

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