MEDICAL POLICY
POLICY TITLE
FLUORESCENT TREPONEMAL ANTIBODY ABSORPTION TEST
(FTA-ABS)
POLICY NUMBER
MP-2.223
Original Issue Date:
August 9, 2002
Most Recent Review Date:
June 15, 2004
Effective Date:
August 31, 2004- RETIRED
I.
DESCRIPTION/BACKGROUND
Fluorescent treponemal antibody absorption test (FTA-ABS) is a blood test used to confirm
the diagnosis of syphilis. Syphilis is an infectious disease caused by the bacteria
Treponema pallidum and is most often transmitted by sexual contact. The test detects the
presence of antibodies specific to the Treponema pallidum bacteria. Since screening tests
may miss cases of early (primary) or late (tertiary) syphilis, FTA-ABS may be used to
improve diagnostic yield. FTA-ABS will remain positive for life even after syphilis has
been adequately treated.
II.
DEFINITIONS
PRIMARY SYPHILIS is the first stage, marked by the appearance of a small painless red
pustule on the skin or mucous membrane between ten and ninety days after exposure. The
lesion may appear anywhere on the body where contract with a lesion on an infected
person has occurred, but it is seen most often in the anogenital region. The lesion quickly
erodes, forming a painless, bloodless ulcer, called a chancre, exuding a fluid that swarms
with spirochetes.
TERTIARY SYPHILIS is the third stage, and may not develop for three to fifteen years. It is
characterized by the appearance of soft rubbery tumors, called gummas that ulcerate and
heal by scarring. Tertiary syphilis may be painless, unnoticed except for the gummas, or
may be accompanied by deep, burrowing pain.
III.
POLICY
Fluorescent treponemal antibody absorption test (FTA-ABS) may be considered medically
necessary when there is documented clinical indications suggestive of syphilis.
IV.
EXCLUSIONS
FTA-ABS cannot be used to monitor the treatment of syphilis.
V.
VARIATIONS
Benefit determinations should be based in all cases on the applicable contract language.
Coverage is determined according to individual or group customer benefits.
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[Note: Final page is signature page and is kept on file, but not issued with Policy.]
MEDICAL POLICY
POLICY TITLE
FLUORESCENT TREPONEMAL ANTIBODY ABSORPTION TEST
(FTA-ABS)
POLICY NUMBER
MP-2.223
VI. REFERENCES
MedlinePlus Medical Encyclopedia: FTA-ABS [Website]
http://www.nlm.nih.gov/medlineplus/ency/article/003512.htm accessed April 19, 2004.
Mosby’s Medical, Nursing, & Allied Health Dictionary, 6th edition
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[Note: Final page is signature page and is kept on file, but not issued with Policy.]