
Optima Health Laboratory Testing Policies
Optima Health has partnered with Avalon Healthcare Solutions for Laboratory Benefits Management (LBM). The laboratory testing policies are accessible through the links below. These policies have been modified for Optima Health’s various products to align with government program policies, rules, and/or state and federal contracts, but note that in case of conflict, the government program policies, rules, and/or state and federal contracts will take precedence.
DISCLAIMER: Application of coverage criteria is dependent upon an individual’s benefit coverage at the time of the request. If there is a conflict between this Policy and any relevant, applicable government policy [e.g. Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs) for Medicare] for a particular member, then the government policy will be used to make the determination. For the most up-to-date Medicare policies and coverage, please visit their search website https://www.cms.gov/medicare-coverage-database/search.aspx or
the manual website.
- F2019: Flow Cytometry
- G2002: Cervical Cancer Screening
- G2005: Vitamin D Testing
- G2006: Hemoglobin A1c
- G2007: Prostate Biopsies
- G2008: Prostate Specific Antigen (PSA) Testing
- G2009: Preventive Screening in Adults
- G2011: Diagnostic Testing of Iron Hemostasis & Metabolism
- G2013: Testosterone
- G2014: Vitamin B12 and Methylmalonic Acid Testing
- G2022: ANA and ENA Testing
- G2031: Allergen Testing
- G2035: Prenatal Screening (Nongenetic)
- G2036: Hepatitis C
- G2042: Pediatric Preventive Screening
- G2043: Celiac Disease Testing
- G2044: Helicobacter pylori Testing
- G2045: Thyroid Disease Testing
- G2048: Biochemical Markers of Alzheimer Disease and Dementia
- G2050: Cardiovascular Disease Risk Assessment
- G2051: Bone Turnover Markers Testing
- G2056: Diagnosis of Idiopathic Environmental Intolerance
- G2059: Epithelial Cell Cytology in Breast Cancer Risk Assessment
- G2060: Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing
- G2061: Fecal Calprotectin Testing in Adults
- G2063: Testing for Diagnosis of Active or Latent Tuberculosis
- G2098: Immune Cell Function Assay
- G2099: Intracellular Micronutrient Analysis
- G2100: In Vitro Chemoresistance and Chemosensitivity Assays
- G2105: Immunopharmacologic Monitoring of Therapeutic Serum Antibodies
- G2107: Measurement of Thromboxane Metabolites for ASA Resistance
- G2110: Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease
- G2113: Oral Screening, Lesion Identification Systems and Genetic Screening
- G2115: Monitoring Metabolite Markers of Thiopurines
- G2119: Diagnostic Testing of Influenza
- G2120: Salivary Hormone Testing
- G2121: Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease
- G2123: Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases
- G2124: Serum Tumor Markers for Malignancies
- G2125: Urinary Tumor Markers For Bladder Cancer
- G2127: Vectra DA Blood Test for Rheumatoid Arthritis
- G2130: ST2 Assay for Chronic Heart Failure
- G2132: Erectile Dysfunction
- G2133: ZIKA Virus Risk Assessment
- G2138: Evaluation of Dry Eyes
- G2143: Lyme Disease
- G2149: Pathogen Panel Testing
- G2150: Cardiac Biomarkers for Myocardial Infarction
- G2153: Pancreatic Enzyme Testing for Acute Pancreatitis
- G2154: Folate Testing
- G2155: General Inflammation Testing
- G2156: Urine Culture Testing for Bacteria
- G2157: Diagnostic Testing of Common Sexually Transmitted Infections
- G2158: Testing for Mosquito- or Tick-Related Infections
- G2159: Streptococcus Testing
- G2164: Parathyroid Hormone, Phosphorous, Calcium, and Magnesium Testing
- G2173: Gamma-glutamyl Transferase
- M2057: Diagnosis of Vaginitis including Multi-target PCR Testing
- M2097: Identification of Microorganisms Using Nucleic Acid Probes
- M2112: Nerve Fiber Density Testing
- M2116: Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection
- M2172: Onychomycosis Testing
- P2018: Immunohistochemistry
- R2162: Avalon Laboratory Procedures Reimbursement Policy
- T2015: Prescription Medication and Illicit Drug Testing in the Outpatient Setting