ExhibitFFBP_TB_Algorithm_(1).pdf

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US MEPCOM Fee Basis Providers
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W81K04-18-R-0003
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Exhibit F-FBP TB Alorithm

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Text version

Updated 2/24/16

Required TB Testing Documentation for FBP Candidate File

**TST

positive

Hx of BCG vaccination

No Hx of BCG vaccination

Need IGRA blood test

Positive IGRA

Negative IGRA

CXR

Documentation in the file

Negative CXR-documentation in the file of TST skin test, blood test and CXR result

Positive CXR - *Documentation for the file- letter from Medical (per CDC guideline) to include medical evaluation, course of action/treatment taken and non -communicable status, ability to work

CXR negative *Documentation for file –letter from Medical (per CDC guideline) to include prophylactic treatment with specific medication regimen for LTBI started, completed or rationale for no prophylactic treatment needed

CXR positive

*Documentation for the file- letter from Medical (per CDC guideline) to include medical evaluation, course of action/treatment taken and non -communicable status, ability to work

1-References: www.CDC.gov, Treatment and Monitoring of TB. Guideline for Preventing and Transmission of M. TB in Health Care Settings, 2005 (this is the most up to date reference from CDC on this issue) 2-AR 40-64 p12(d)

TST: Tuberculin skin testing BCG:Bacillus Calmette Guerin Hx: History CXR: Chest Xray IGRA: Interferon-gamma release assays. The 2 tests approved currently are QuantiFERON Gold and T-SPOT TB test LTBI- Latent TB infection *No specific time period on the letter i.e. it is 2015 and letter is from 2005 as long as there is documentation of updated symptom screening (the Physical Exam for employment with Fee Base Vendor needs to include documentation of screening for tb symptoms in patients with history of LTBI).

**If the provider has a documented history of positive skin test, can start with IGRA http://www.cdc.gov/ alfredo.fuerte Typewritten Text

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