Summary & Overview
CPT 78267: C-14 Urea Breath Test for Helicobacter pylori
CPT code 78267 represents the C–14 urea breath test used to diagnose Helicobacter pylori infection in the stomach. The test involves administering a C–14–labeled urea solution and measuring labeled carbon in the patient’s exhaled breath, providing a noninvasive diagnostic option for H. pylori. Nationally, this code matters because H. pylori testing is a common step in diagnosing and managing peptic ulcer disease and dyspepsia, affecting clinical pathways and testing utilization across outpatient settings.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context, expected sites of service, and common billing practices tied to this test. The publication outlines national benchmarks for use and places the code in clinical perspective, including when the test is typically ordered and how it fits into diagnostic algorithms for H. pylori.
The report provides: a clear description of the coded service, payer coverage landscape, and operational considerations for outpatient diagnostic settings. Data not available in the input is noted where specific utilization metrics, ICD-10 mappings, and related codes would normally appear.
Billing Code Overview
CPT code 78267 describes administration of a radioactive isotope C–14 labeled urea solution to the patient to diagnose infection of the stomach with Helicobacter pylori. This service is a diagnostic breath test that detects H. pylori by measuring labeled carbon in exhaled breath after ingestion of the C–14 urea solution.
Service Type: Diagnostic imaging/laboratory breath test
Typical Site of Service: Outpatient clinic, hospital outpatient department, or ambulatory diagnostic center
Clinical & Coding Specifications
Clinical Context
A 45-year-old adult presents to an outpatient nuclear medicine clinic with a several-week history of dyspepsia, epigastric pain, and suspected peptic ulcer disease after failed empirical therapy. The gastroenterologist orders a noninvasive urea breath test using a C-14 labeled urea solution to detect active Helicobacter pylori infection. The patient fasts for the required pretest interval, and medications that interfere with H. pylori testing (proton-pump inhibitors, antibiotics, bismuth) are held per protocol. At arrival, the nuclear medicine technologist reviews indications and consent, administers the C-14 urea solution orally, and collects exhaled breath samples at specified intervals for radioactivity measurement. The physician interprets the results and documents presence or absence of H. pylori infection. Typical sites of service are outpatient radiology/nuclear medicine or hospital outpatient clinic. The service type is a diagnostic nuclear medicine test with specimen collection via breath sampling and radioactive tracer administration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation/report and not the technical administration of the test. |