Researchers from University of Arizona College of Pharmacy Report on Findings in Pulmonary and Critical Care Medicine (Payer Coverage of Valley Fever Diagnostic Tests): Health and Medicine – Pulmonary and Critical Care Medicine

2021 DEC 28 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Researchers detail new data in pulmonary and critical care medicine. According to news originating from Tucson, Arizona, by NewsRx correspondents, research stated, “The nonspecific symptoms of Valley fever, or coccidioidomycosis, hinders its proper diagnosis. This results in unnecessary health care costs and antibiotic usage.”

The news reporters obtained a quote from the research from University of Arizona College of Pharmacy: “Thus, this study seeks to determine the coverage of the Valley fever diagnostic test as provided by Arizona insurance companies to increase early diagnosis rates. Through scripted messaging and telephone communications, we contacted 40 health insurance companies in Arizona about their coverage of CPT 86635 (antibody diagnostic assay for Coccidioides) without prior authorization under all plan types provided in both primary and urgent care settings. If prior authorization was required, we discussed the coverage of ICD-10 codes J18.9 (pneumonia, unspecified organism), J18.1 (lobar pneumonia, unspecified organism), or L52 (erythema nodosum). Of the 40 health insurance companies contacted, 25 did not answer our inquiries, most requiring member-specific information to share coverage data. The remaining 15 companies covered Valley fever testing, of which 4 required prior authorization for the ICD-10 codes of interest. Of these 15 companies, 14 provided coverage in primary and urgent care settings, and 13 provided coverage for all available plans.”

According to the news editors, the research concluded: “All payers that provided information covered Valley Fever testing. Most of the insurance companies that were unable to answer our inquiry likely cover Valley fever testing, but were unable to share information with third party inquiries. Obtaining general coverage information is difficult, which can potentially impact patient care.”

For more information on this research see: Payer Coverage of Valley Fever Diagnostic Tests. Southwest Journal of Pulmonary and Critical Care, 2021,23(6):155-161. (Southwest Journal of Pulmonary and Critical Care - http://www.swjpcc.com/). The publisher for Southwest Journal of Pulmonary and Critical Care is Arizona Thoracic Society.

A free version of this journal article is available at https://doi.org/10.13175/swjpcc052-21.

Our news journalists report that more information may be obtained by contacting Chloe E Grace Rose, University of Arizona College of Pharmacy, Tucson, AZ, United States. Additional authors for this research include Joshua E Kessler, Jennifer A Weisbrod, Brittanie V Hoang, Amy J Grizzle, Jason T Hurwitz, John N Galgiani.

(Our reports deliver fact-based news of research and discoveries from around the world.)