Description

Ankylosing spondylitis (AS) is a chronic inflammatory disease. It is a type of arthritis that affects the spine. AS can cause pain, stiffness and inflammation from the neck to the lower back and, in severe cases, can cause the vertebrae in the spine to fuse together.

HLA-B*27 (human leukocyte antigen) is a specific protein located on cell surfaces. The term HLA-B*27 is also used to refer to the gene that codes for the HLA-B*27 protein. The HLA-B*27 test determines the presence or absence of HLA-B*27 protein on the surface of an individual's white blood cells.

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Molecular Testing for HLA-B*27 for Ankylosing Spondylitis

Effective Date: 07/27/2023 Revision Date: 07/27/2023 Review Date: 07/27/2023 Policy Number: HUM-0574-005 Page: 2 of 4

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HLA-B*27 was initially identified using serological methods to detect the presence of HLA-B*27 antigen; however, this methodology is no longer used by United States laboratories. Today, DNA-based molecular techniques are used such as polymerase chain reaction (PCR) with restriction fragment length polymorphism (RFLP) analysis, sequence specific primer (SSP) and/or sequence-specific oligonucleotide probe (SSOP). HLA-B*27 testing has been proposed as a method for diagnosing AS.

Coverage Determination

Humana members may NOT be eligible under the Plan for molecular testing for HLA-B*27 for ankylosing spondylitis. This is considered experimental/ investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Note: The criteria for molecular testing for HLA-B*27 for ankylosing spondylitis is not consistent with the Medicare National Coverage Policy and therefore may not be applicable to Medicare members. Refer to the CMS website for additional information.

Additional information about ankylosing spondylitis may be found from the following websites:

• BackgroundNational Library of Medicine
• Spondylitis Association of America

Medical Alternatives

Alternatives to molecular testing for HLA-B*27 for ankylosing spondylitis include but may not be limited to:

• Magnetic resonance imaging (MRI)
• X-ray

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific