MACs release new coverage determinations for GI/endoscopy special stains

Three Medicare Administrative Contractors have issued coverage decisions on special stains and immunohistochemical stains for GI/endoscopy, according to an AGA eDigest report.

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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