Rapid Platelet Function Assay

Policy ID: L-42-019

Section: Laboratory

Effective Date: May 01, 2020

Revised Date: July 26, 2022

Revision Effective Date: July 07, 2025

Last Reviewed: May 13, 2025

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.

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date.

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

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 Code

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

Internal Medical Policy Committee 1-14-2025 Annual Review-no changes in criteria

Added Policy Application

Internal Medical Policy Committee 5-13-2025 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-42-018

Section: Laboratory

Effective Date: May 01, 2020

Revised Date: July 26, 2022

Revision Effective Date: March 03, 2025

Last Reviewed: January 14, 2025

Archived Date: July 06, 2025

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.

Policy Application

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

Procedure Code

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

Internal Medical Policy Committee 1-14-2025 Annual Review-no changes in criteria

Added Policy Application

Medical Policies Quick Search

Rapid Platelet Function Assay

Description

Policy Application

Criteria

Procedure Code

Diagnosis Codes

Non-Covered Diagnosis Code for 85576

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer

Description

Policy Application

Criteria

Procedure Code

Diagnosis Codes

Non-Covered Diagnosis Code for 85576

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer