HIGHMARK COMMERCIAL MEDICAL POLICY - PENNSYLVANIA

 
 

Medical Policy:
L-42-013
Topic:
Rapid Platelet Function Assay - ASA
Section:
Laboratory
Effective Date:
October 30, 2017
Issued Date:
January 28, 2019
Last Revision Date:
January 2019
Annual Review:
January 2019
 
 

 

The Rapid Platelet Function Assay - ASA (RPFA-ASA, Mutiplate ® Assay, VerifyNow P2Y12 Assay) is a quantitative test developed to aid in identifying platelet dysfunction due to aspirin therapy. 

Timely identification of aspirin-resistant patients is clinically significant because it provides the opportunity to change or augment therapy before a vascular event occurs.

 

Policy Position

Rapid Platelet Function Assay is considered investigational/experimental and therefore non-covered. Scientific evidence does not demonstrate the efficacy of its use.

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Place of Service: Inpatient/Outpatient

Experimental/Investigational (E/I) services are not covered regardless of place of service.

Rapid Platelet Function Assay - ASA is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.


The policy position applies to all commercial lines of business



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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical or other circumstances may warrant individual consideration, based on review of applicable medical records, as well as other regulatory, contractual and/or legal requirements.

Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.

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    U.S. Department of Health and Human Services
    200 Independence Avenue, SW
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    1-800-368-1019, 800-537-7697 (TDD)

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