Coverage Requirements for HLA-B27 Vary by Testing Methodology

Did you know a laboratory can perform one of two different tests when a provider orders an HLA-B27 blood test? The ACR Insurance Subcommittee has received several complaints regarding commercial payer coverage for these tests, depending on which methodology the lab employs. To avoid administrative burden, members should familiarize themselves with lab practices and payer coverage details prior to ordering the test.

There are two methodologies for running the HLA-B27 test: a serologic test using flow cytometry (CPT 86812) and a molecular test, which uses polymerase chain reaction (PCR) based methodology (CPT 81374). Although some labs are equipped to run both tests, others offer only one. The PCR test is often more expensive, and payers tend to categorize it with genetic and molecular tests. As a result, it may be subject to additional requirements, such as prior authorization and even genetic counseling. Members are encouraged to review which test(s) their partner labs perform prior to ordering the test, because your patients’ insurance requirements vary.

For assistance or additional information on this issue, contact practice@rheumatology.org.