Multiplex Polymerase Chain Reaction (mPCR) or Nucleic acid Pathogen Testing for Infectious Disease Form

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Multiplex Polymerase Chain Reaction (mPCR) or Nucleic acid Pathogen Testing for Infectious Disease Medical Guideline

Service: Multiplex Polymerase Chain Reaction (mPCR) or Nucleic acid Pathogen Testing for Infectious Disease

PUM 250-0021-1809

Medical Guideline Committee Approval Q2-06/2025 Effective Date 09/01/2025

Coverage for multiplex polymerase chain reaction (mPCR) or Nucleic pathogen testing for Infectious disease may vary across plans. Refer to the member’s benefit plan document for coverage details.

Description:

Pathogens, including bacteria, viruses, and parasites can cause acute infections in the gastrointestinal, central nervous system, respiratory, and vaginal tracts. For most individuals without a high-risk comorbidity or severe illness, watchful management for several days without microbiologic testing (cultures or multiplex PCR panel tests) is routinely appropriate. Most infectious causes of acute infections are self-limited and viral etiology. Traditional diagnostic methods include bacterial culture, antibody/antigen testing, and microscopy (with stains and/or immunofluorescence). Newer, genetic testing methods may be used to detect infectious pathogens. Specifically, nucleic acid amplification, commonly polymerase chain reaction (PCR), amplifies the amount of genetic material present in a sample, allowing easier detection, typically with faster results from traditional methods. Panels test simultaneously for multiple pathogenic microbes within a sample.

This guideline addresses rapid PCR multiplex testing and nucleic acid testing for greater than 5 pathogens in individuals with acute infections. Standard laboratory protocols include testing for up to 5 pathogens, testing for 6-11 pathogens, and testing for 12-25 (or more) pathogens. However, several of the included pathogens are determined by the laboratory/manufacturer, rather than by likelihood of actionable results. The clinical utility of panel testing for more than 5 of the most common gastrointestinal, central nervous system, respiratory, vaginal, and genital tract, including sexually transmitted pathogens, in an ambulatory/outpatient setting has not been well-established in evidence- based literature.

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Indications of Coverage:
Multiplex Polymerase Chain Reaction (mPCR) or nucleic acid testing of gastrointestinal, respiratory, central nervous system, sexually transmitted infection, and vaginal pathogens:

1. Testing for less than or equal to 5 gastrointestinal (GI), central nervous system, respiratory, vaginal, or sexually transmitted infection (STI) pathogens is considered medically necessary in an ambulatory setting and does not require medical necessity review.

2. For gastrointestinal pathogen testing of greater than 5 pathogens, ONE of the following must be met to be considered medically necessary:

   A. Community acquired diarrhea with symptoms of at least 7 days duration.

   B. Severe diarrhea with any of the following: need for hospitalization, signs of dehydration or hypovolemia (dry mucous membranes, tachycardia, orthostatic hypotension).

   C. Fever or bloody diarrhea

   D. Diarrhea in a high-risk patient, such as immunocompromised state (prior transplant, HIV infection, chronic steroid use, receiving cancer treatment, or other immunocompromised state).

   E. Diarrhea and prior diagnostic testing of stool culture/ova/parasites during the current illness has failed to yield a pathogenic organism.

3. For respiratory pathogen testing of greater than 5 pathogens are considered medically necessary, when prior respiratory culture during the current illness has failed to yield a pathogenic organism, OR when ALL the following are met:

   A. Signs and symptoms of a respiratory infection.

   B. Test results will be used to guide therapy.

   C. Member is immunocompromised or considered high-risk for complications due to co-morbid conditions (severe heart or lung disease), HIV infection, or chronic steroid use.

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4. Central nervous system testing of cerebrospinal fluid is considered medically necessary when there is clinical suspicion of central nervous system infection (e.g., meningitis, encephalitis).

   NOTE: Testing for more than five vaginal pathogens with symptomatic vaginitis is considered not medically necessary. Multiplex testing or multi-Target panels for identifying pathogens of the urinary tract (cystitis, pyelonephritis, prostatitis) are considered not medically necessary in an ambulatory/outpatient setting.

   Limitations of Coverage:

   Benefit Limitations: Please note that in listing services or examples, when we say, “this includes,” it is not our intent to limit the description to that specific list. When we do intend to limit a list of services or examples, we state specifically that the list “is limited to”.

5. Review contract and endorsements for exclusions and prior authorization or benefit limits or requirements.

6. If used for a condition/diagnosis other than is listed in the Indications of Coverage, it will be considered experimental, investigational, and unproven to affect health outcomes.

7. If used for a condition/diagnosis that is listed in the Indications of Coverage, but the criteria are not met, it will be considered not medically necessary.

8. Multiplex testing or multi-Target panels for identifying pathogens of the urinary tract (cystitis, pyelonephritis, prostatitis) are considered not medically necessary in an ambulatory/outpatient setting.

9. Multiplex testing or multi-Target panels (greater than 5 targets) for identifying pathogens of the genital tract, including sexually transmitted infection (STI) or resultant vaginitis are considered not medically necessary.

   Documentation Required:

   • Standard Written Order (SWO), prescribed by a qualified healthcare provider concerning the member’s diagnosis.
   • Medical record information (including continued need/use if applicable) and medical necessity, including Acute signs/symptoms of infection in

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gastrointestinal, central nervous system, respiratory, genital tract, including sexually transmitted infection (STI), or vaginal system; and documentation by the ordering provider of the need for rapid result and the need to test for each of the pathogens identified on the panel.
• Correct coding for the item/service that meets all the coding guidelines.

Disclaimer: This guideline is for informational purposes only and does not constitute medical advice, plan authorization, an explanation of benefits, or a guarantee of payment. Benefit plans vary in coverage and some plans may or may not provide coverage for all services listed in this guideline. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and federal law. Some benefit plans administered by the organization may not utilize Medical Affairs medical guideline in all their coverage determinations. Contact customer services as listed on the member card for specific plan, benefit, and network status information.

Medical guidelines are based on constantly changing medical science and are reviewed annually and subject to change. The organization uses tools developed by third parties, such as the evidence-based clinical guidelines developed by MCG to assist in administering health benefits. This medical guideline and MCG guidelines are intended to be used in conjunction with the independent professional medical judgment of a qualified health care provider. To obtain additional information about MCG, email medical.policies@wpsic.com. Coverage of all services is subject to medical necessity and services deemed experimental, investigational, and/or unproven are therefore not considered medically necessary under the terms of the clinical guidelines and will not be covered.

Multiplex pathogen testing for infectious disease is considered medically necessary only when indicated per the most current medical references and specialty society guidelines, such as MCG, NCCN, etc.

State mandates, laws or benchmark supersede this medical guideline.

Guideline Review History:

Implemented 01/01/19, 01/01/20, 04/01/21, 11/01/21, 11/01/22, 06/01/23, 02/01/24, 09/01/25 Medical Guideline Committee Approval 09/21/18, 07/26/19, 10/30/20, 10/28/21, 10/27/22, 01/26/23, 01/25/24, 06/26/25 Reviewed

09/21/18, 07/26/19, 10/28/21, 10/27/22, 01/26/23, 01/25/24, 06/26/25 Developed 09/21/18

Approved by the Medical Director

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Codes: The following codes for treatments and procedures applicable to this document are included below for informational purposes.

Code Description 81513 INFECTIOUS DISEASE, BACTERIAL VAGINOSIS, QUANTITATIVE REAL-TIME AMPLIFICATION OF RNA MARKERS FOR ATOPOBIUM VAGINAE, GARDNERELLA VAGINALIS, AND LACTOBACILLUS SPECIES, UTILIZING VAGINAL-FLUID SPECIMENS, ALGORITHM REPORTED AS A POSITIVE OR NEGATIVE RESULT FOR BACTERIAL VAGINOSIS

81514 INFECTIOUS DISEASE, BACTERIAL VAGINOSIS AND VAGINITIS, QUANTITATIVE REAL-TIME AMPLIFICATION OF DNA MARKERS FOR GARDNERELLA VAGINALIS, ATOPOBIUM VAGINAE, MEGASPHAERA TYPE 1, BACTERIAL VAGINOSIS ASSOCIATED BACTERIA-2 (BVAB-2), AND LACTOBACILLUS SPECIES (L. CRISPATUS AND L. JENSENII), UTILIZING VAGINAL-FLUID SPECIMENS, ALGORITHM REPORTED AS A POSITIVE OR NEGATIVE FOR HIGH LIKELIHOOD OF BACTERIAL VAGINOSIS, INCLUDES SEPARATE DETECTION OF TRICHOMONAS VAGINALIS AND/OR CANDIDA SPECIES (C. ALBICANS, C. TROPICALIS, C. PARAPSILOSIS, C. DUBLINIENSIS), CANDIDA GLABRATA, CANDIDA KRUSEI, WHEN REPORTED

87483 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CENTRAL NERVOUS SYSTEM PATHOGEN (E.G., NEISSERIA MENINGITIDIS, STREPTOCOCCUS PNEUMONIAE, LISTERIA, HAEMOPHILUS INFLUENZAE, E. COLI, STREPTOCOCCUS AGALACTIAE, ENTEROVIRUS, HUMAN HERPESVIRUS 6, CYTOMEGALOVIRUS, VARICELLA ZOSTER VIRUS, CRYPTOCOCCUS), INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, MULTIPLE TYPES OR SUBTYPES, 12-25 TARGETS 87505 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GASTROINTESTINAL PATHOGEN (EG, CLOSTRIDIUM DIFFICILE, E. COLI, SALMONELLA, SHIGELLA, NOROVIRUS, GIARDIA), INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, MULTIPLE TYPES OR SUBTYPES, 3-5 TARGETS

87506 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GASTROINTESTINAL PATHOGEN (EG, CLOSTRIDIUM DIFFICILE, E. COLI, SALMONELLA, SHIGELLA, NOROVIRUS, GIARDIA), INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, MULTIPLE TYPES OR SUBTYPES, 6-11 TARGETS

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87507 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GASTROINTESTINAL PATHOGEN (EG, CLOSTRIDIUM DIFFICILE, E. COLI, SALMONELLA, SHIGELLA, NOROVIRUS, GIARDIA), INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, MULTIPLE TYPES OR SUBTYPES, 12-25 TARGETS 87631 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZA VIRUS, CORONAVIRUS, METAPNEUMOVIRUS, PARAINFLUENZA VIRUS, RESPIRATORY SYNCYTIAL VIRUS, RHINOVIRUS), INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, MULTIPLE TYPES OR SUBTYPES, 3-5 TARGETS

87632 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZA VIRUS, CORONAVIRUS, METAPNEUMOVIRUS, PARAINFLUENZA VIRUS, RESPIRATORY SYNCYTIAL VIRUS, RHINOVIRUS), INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, MULTIPLE TYPES OR SUBTYPES, 6-11 TARGETS

87633 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZA VIRUS, CORONAVIRUS, METAPNEUMOVIRUS, PARAINFLUENZA VIRUS, RESPIRATORY SYNCYTIAL VIRUS, RHINOVIRUS), INCLUDES MULTIPLEX REVERSE TRANSCRIPTION, WHEN PERFORMED, AND MULTIPLEX AMPLIFIED PROBE TECHNIQUE, MULTIPLE TYPES OR SUBTYPES, 12-25 TARGETS

0115U RESPIRATORY INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA AND RNA), 18 VIRAL TYPES AND SUBTYPES AND 2 BACTERIAL TARGETS, AMPLIFIED PROBE TECHNIQUE, INCLUDING MULTIPLEX REVERSE TRANSCRIPTION FOR RNA TARGETS, EACH ANALYTE REPORTED AS DETECTED OR NOT DETECTED

0202U INFECTIOUS DISEASE (BACTERIAL OR VIRAL RESPIRATORY TRACT INFECTION), PATHOGEN-SPECIFIC NUCLEIC ACID (DNA OR RNA), 22 TARGETS INCLUDING SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2), QUALITATIVE RT-PCR, NASOPHARYNGEAL SWAB, EACH PATHOGEN REPORTED AS DETECTED OR NOT DETECTED

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0223U INFECTIOUS DISEASE (BACTERIAL OR VIRAL RESPIRATORY TRACT INFECTION), PATHOGEN-SPECIFIC NUCLEIC ACID (DNA OR RNA), 22 TARGETS INCLUDING SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2), QUALITATIVE RT-PCR, NASOPHARYNGEAL SWAB, EACH PATHOGEN REPORTED AS DETECTED OR NOT DETECTED

0225U INFECTIOUS DISEASE (BACTERIAL OR VIRAL RESPIRATORY TRACT INFECTION) PATHOGEN-SPECIFIC DNA AND RNA, 21 TARGETS, INCLUDING SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2), AMPLIFIED PROBE TECHNIQUE, INCLUDING MULTIPLEX REVERSE TRANSCRIPTION FOR RNA TARGETS, EACH ANALYTE REPORTED AS DETECTED OR NOT DETECTED

0240U INFECTIOUS DISEASE (VIRAL RESPIRATORY TRACT INFECTION), PATHOGEN-SPECIFIC RNA, 3 TARGETS (SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 [SARS-COV-2], INFLUENZA A, INFLUENZA B), UPPER RESPIRATORY SPECIMEN, EACH PATHOGEN REPORTED AS DETECTED OR NOT DETECTED

0241U INFECTIOUS DISEASE (VIRAL RESPIRATORY TRACT INFECTION), PATHOGEN-SPECIFIC RNA, 4 TARGETS (SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 [SARS-COV-2], INFLUENZA A, INFLUENZA B, RESPIRATORY SYNCYTIAL VIRUS [RSV]), UPPER RESPIRATORY SPECIMEN, EACH PATHOGEN REPORTED AS DETECTED OR NOT DETECTED

0321U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), GENITOURINARY PATHOGENS, IDENTIFICATION OF 20 BACTERIAL AND FUNGAL ORGANISMS AND IDENTIFICATION OF 16 ASSOCIATED ANTIBIOTIC-RESISTANCE GENES, MULTIPLEX AMPLIFIED PROBE TECHNIQUE

0323U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA AND RNA), CENTRAL NERVOUS SYSTEM PATHOGEN, METAGENOMIC NEXT- GENERATION SEQUENCING, CEREBROSPINAL FLUID (CSF), IDENTIFICATION OF PATHOGENIC BACTERIA, VIRUSES, PARASITES, OR FUNGI

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0330U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), VAGINAL PATHOGEN PANEL, IDENTIFICATION OF 27 ORGANISMS, AMPLIFIED PROBE TECHNIQUE, VAGINAL SWAB

0352U INFECTIOUS DISEASE (BACTERIAL VAGINOSIS AND VAGINITIS), MULTIPLEX AMPLIFIED PROBE TECHNIQUE, FOR DETECTION OF BACTERIAL VAGINOSIS ASSOCIATED BACTERIA (BVAB-2, ATOPOBIUM VAGINAE, AND MEGASPHERA TYPE 1), ALGORITHM REPORTED AS DETECTED OR NOT DETECTED AND SEPARATE DETECTION OF CANDIDA SPECIES (C. ALBICANS, C. TROPICALIS, C. PARAPSILOSIS, C. DUBLINIENSIS), CANDIDA GLABRATA/CANDIDA KRUSEI, AND TRICHOMONAS VAGINALIS, VAGINAL-FLUID SPECIMEN, EACH RESULT REPORTED AS DETECTED OR NOT DETECTED

0353U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA), CHLAMYDIA TRACHOMATIS AND NEISSERIA GONORRHOEAE, MULTIPLEX AMPLIFIED PROBE TECHNIQUE, URINE, VAGINAL, PHARYNGEAL, OR RECTAL, EACH PATHOGEN REPORTED AS DETECTED OR NOT DETECTED

0369U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA AND RNA), GASTROINTESTINAL PATHOGENS, 31 BACTERIAL, VIRAL, AND PARASITIC ORGANISMS AND IDENTIFICATION OF 21 ASSOCIATED ANTIBIOTIC- RESISTANCE GENES, MULTIPLEX AMPLIFIED PROBE TECHNIQUE 0370U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA AND RNA), SURGICAL WOUND PATHOGENS, 34 MICROORGANISMS AND IDENTIFICATION OF 21 ASSOCIATED ANTIBIOTIC-RESISTANCE GENES, MULTIPLEX AMPLIFIED PROBE TECHNIQUE, WOUND SWAB 0371U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), GENITOURINARY PATHOGEN, SEMIQUANTITATIVE IDENTIFICATION, DNA FROM 16 BACTERIAL ORGANISMS AND 1 FUNGAL ORGANISM, MULTIPLEX AMPLIFIED PROBE TECHNIQUE VIA QUANTITATIVE POLYMERASE CHAIN REACTION (QPCR), URINE

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0372U INFECTIOUS DISEASE (GENITOURINARY PATHOGENS), ANTIBIOTIC- RESISTANCE GENE DETECTION, MULTIPLEX AMPLIFIED PROBE TECHNIQUE, URINE, REPORTED AS AN ANTIMICROBIAL STEWARDSHIP RISK SCORE 0373U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA AND RNA), RESPIRATORY TRACT INFECTION, 17 BACTERIA, 8 FUNGUS, 13 VIRUS, AND 16 ANTIBIOTIC-RESISTANCE GENES, MULTIPLEX AMPLIFIED PROBE TECHNIQUE, UPPER OR LOWER RESPIRATORY SPECIMEN 0374U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), GENITOURINARY PATHOGENS, IDENTIFICATION OF 21 BACTERIAL AND FUNGAL ORGANISMS AND IDENTIFICATION OF 21 ASSOCIATED ANTIBIOTIC-RESISTANCE GENES, MULTIPLEX AMPLIFIED PROBE TECHNIQUE, URINE 0402U INFECTIOUS AGENT (SEXUALLY TRANSMITTED INFECTIONS), CHLAMYDIA TRACHOMATIS, NEISSERIA GONORRHOEA, TRICHOMONAS VAGINALIS, MYCOPLASMA GENITALIUM, MULTIPLEX AMPLIFIED PROBE TECHNIQUE, VAGINAL, ENDOCERVICAL, OR MALE URINE, EACH PATHOGEN REPORTED AS DETECTED OR NOT DETECTED. 0416U INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA), GENITOURINARY PATHOGENS, IDENTIFICATION OF 20 BACTERIAL AND FUNGAL ORGANISMS, INCLUDING IDENTIFICATION OF 20 ASSOCIATED ANTIBIOTIC-RESISTANCE GENES, IF PERFORMED, MULTIPLEX AMPLIFIED PROBE TECHNIQUE, URINE 0455U INFECTIOUS AGENTS (SEXUALLY TRANSMITTED INFECTION), CHLAMYDIA TRACHOMATIS, NEISSERIA GONORRHOEAEA, AND TRICHOMONAS VAGINALIS, MULTIPLEX AMPLIFIED PROBE TECHNIQUE, VAGINAL, ENDOCERVICAL, GYNECOLOGICAL SPECIMENS, OROPHARYNGEAL SWABS, RECTAL SWABS, FEMALE OR MALE URINE, EACH PATHOGEN REPORTED AS DETECTED OR NOT DETECTED

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0504U INFECTIOUS DISEAE (URINARY TRACT INFECTION), IDENTIFICATION OF 17 PATHOLOGIC ORGANISMS, URINE, REAL-TIME PCR, REPORTED AS POSITIVE OR NEGATIVE FOR EACH ORGANISM 0505U INFECTIOUS DISEASE (VAGINAL INFECTION), IDENTIFICATION OF 32 PATHOGENIC ORGANISMS, SWAB, REAL-TIME PCR, REPORTED AS POSITIVE OR NEGATIVE FOR EACH ORGANISM 0556U INFECTIOUS DISEASE (BACTERIAL OR VIRAL RESPIRATORY TRACT INFECTION), PATHOGEN-SPECIFIC DNA AND RNA BY REAL-TIME PCR, 12 TARGETS, NASOPHARYNGEAL OR OROPHARYNGEAL SWAB, INCLUDING MULTIPLEX REVERSE TRANSCRIPTION FOR RNA TARGETS, EACH ANALYTE REPORTED AS DETECTED OR NOT DETECTED 0557U INFECTIOUS DISEASE (BACTERIAL VAGINOSIS AND VAGINITIS), REAL-TIME AMPLIFICATION OF DNA MARKERS FOR ATOPOBIUM VAGINAE, GARDNERELLA VAGINALIS, MEGASPHAERA TYPES 1 AND 2, BACTERIAL VAGINOSIS ASSOCIATED BACTERIA-2 AND -3 (BVAB-2, BVAB-3), MOBILUNCUS SPECIES, TRICHOMONAS VAGINALIS, NEISSERIA GONORRHOEAE, CANDIDA SPECIES (C. ALBICANS, C. TROPICALIS, C. PARAPSILOSIS, C. GLABRATA, C. KRUSEI), HERPES SIMPLEX VIRUSES 1 AND 2, VAGINAL FLUID, REPORTED AS DETECTED OR NOT DETECTED FOR EACH ORGANISM 0563U INFECTIOUS DISEASE (BACTERIAL AND/OR VIRAL RESPIRATORY TRACT INFECTION), PATHOGEN-SPECIFIC NUCLEIC ACID (DNA OR RNA), 11 VIRAL TARGETS AND 4 BACTERIAL TARGETS, QUALITATIVE RT-PCR, UPPER RESPIRATORY SPECIMEN, EACH PATHOGEN REPORTED AS POSITIVE OR NEGATIVE 0564U INFECTIOUS DISEASE (BACTERIAL AND/OR VIRAL RESPIRATORY TRACT INFECTION), PATHOGEN-SPECIFIC NUCLEIC ACID (DNA OR RNA), 10 VIRAL TARGETS AND 4 BACTERIAL TARGETS, QUALITATIVE RT-PCR, UPPER RESPIRATORY SPECIMEN, EACH PATHOGEN REPORTED AS POSITIVE OR NEGATIVE

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