The coverage decisions focus on whether or not special or UHC stains are reasonable and necessary.
Examples not considered reasonable and necessary on every specimen, according to the report, include:
• Esophagus — fungal stains, trichrome, DPAS, CDX-2 or other mucin stains
• Gastric — AB-PAS, D-PAS, CDX-2 or other mucin stains, or special stains or IHC for H. pylori, or neuroendocrine markers, such as synaptophysin or chromogranin
• Duodenum — AB-PAS, D-PAS, CD3 and trichrome, or other mucin stains
• Colon — CD3, p53 trichrome
• Hyperplastic polyps — Ki67, CK20, p53, CEA, BRAF
• Tubular or tubulovillous adenoma — Ki-67, CK20, CEA, p53, MMR
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