This document addresses the current stance on testing for Zika virus (ZIKV), a mosquito-borne flavivirus and member of the Flaviviridae family, which includes RNA real time reverse transcription-polymerase chain reaction (RT-PCR), immunoglobulin M (IgM) and the plaque reduction neutralization test (PRNT).

Clinical Indications

Medically Necessary:

Zika virus testing is considered medically necessary for individuals in accordance with the recommendations of the U.S. Centers for Disease Control and Prevention (CDC).

When the CDC recommendations are updated, the updated guidance regarding testing for Zika virus disease is considered medically necessary as of the effective date of the updated recommendations.

The following tests for Zika virus disease are considered medically necessary, in accordance with the latest CDC recommendations:

• Zika RNA Real-Time RT-PCR (for serum, urine, combined serum and urine, cerebrospinal fluid, amniotic fluid and saliva);
• Zika Virus IgM and Neutralizing Antibody Titers (PRNT) (for serum testing).

Not Medically Necessary:

Zika virus testing is considered not medically necessary for individuals, when not in accordance with the most recent recommendations of the U.S. Centers for Disease Control and Prevention (CDC).

Notes:
*Probable Zika virus exposure is considered when an individual:

1. Resides in an area with ongoing Zika (ZIKV) transmission; or
2. Travel to a country or region with known ZIKV transmission; or
3. Has direct epidemiologic linkage to a person with laboratory evidence of recent ZIKV infection (for example, sexual contact, in utero or perinatal transmission, blood transfusion, organ transplantation); or
4. Association in time and place with a confirmed or probable case.

***Clinical Criteria (signs and symptoms of Zika infection):
A person with one or more of the following:

• Acute onset of fever (measured or reported);
• Maculopapular rash;
• Arthralgia;
• Conjunctivitis;
• Complication of pregnancy:
  • fetal loss in a mother with compatible illness and/or epidemiologic risk factors; or
  • in utero findings of microcephaly and/or intracranial calcifications with maternal risk factors;
• Guillain-Barré syndrome not known to be associated with another diagnosed etiology.

**No data is available to determine how long Zika virus is present in semen. (http://www.cdc.gov/zika/transmission/sexual-transmission.html)