Anthem Blue Cross Connecticut LAB.00039 Pooled Antibiotic Sensitivity Testing Form

This document addresses pooled antibiotic sensitivity testing (P-AST) of urine in combination with a Multiplex Polymerase Chain Reaction (M-PCR) assay for the identification of susceptible urine pathogens and antibiotic resistance genes. This assay testing is proposed for use in the outpatient setting for treatment of recurrent, persistent, and complicated urinary tract infections (UTI) that have been refractory to conventional antibiotics.

Position Statement

Investigational and Not Medically Necessary:

Pooled antibiotic sensitivity testing is considered investigational and not medically necessary in the outpatient setting for all indications.