Rapid Platelet Function Assay

Policy ID: L-42-018

Section: Laboratory

Effective Date: May 01, 2020

Revised Date: July 26, 2022

Revision Effective Date: March 04, 2024

Last Reviewed: January 16, 2024

Applies To: Commercial and Medicaid Expansion

Description

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 individuals is clinically significant because it provides the opportunity to change or augment therapy before a vascular event occurs.

Criteria

Rapid Platelet Function Assay -ASA to determine aspirin resistance is considered experimental/investigational and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Codes

85576

Diagnosis Codes

Non-Covered Diagnosis Code for 85576

Z79.82

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 3-16-2020 Adopted for ND

Internal Medical Policy Committee 3-17--2021 Annual Review-no changes

Internal Medical Policy Committee 11-23-2021 Revision

Updated clarifying language

Internal Medical Policy Committee 7-21-2022

Made correction to experimental/investigational statement.

Internal Medical Policy Committee 1-16-2024 Annual Review-no changes in criteria

Links

References (PDF)

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.

Policy ID: L-42-017

Section: Laboratory

Effective Date: May 01, 2020

Revised Date: October 26, 2021

Revision Effective Date: January 03, 2022

Last Reviewed: November 23, 2021

Archived Date: September 04, 2022