Summary & Overview
CPT 78268: C-14 Urea Breath Test for Helicobacter pylori
CPT code 78268 denotes a diagnostic breath test in which a provider analyzes breath samples using a scintillation counter after oral administration of a C-14 labeled urea solution to detect Helicobacter pylori infection. This noninvasive laboratory procedure is nationally relevant as a common, low-risk method for confirming H. pylori when clinicians require nonendoscopic testing or to verify eradication after therapy.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service and service type, and what to expect in payer coverage and claims handling. The publication covers benchmarking points and common billing considerations tied to the procedure, as well as policy and reimbursement themes that affect national utilization. Practical items include how the test is positioned in diagnostic algorithms for dyspepsia and peptic ulcer disease, and the role of breath testing compared with serology or stool antigen testing.
Where specific payer policies, modifiers, or coding adjacencies are not provided in the input, the report flags those items as not available and focuses on the clinical and billing characteristics that influence coverage and claim processing.
Billing Code Overview
CPT code 78268 describes analysis of breath samples using a scintillation counter after administration of a C-14 labeled urea solution to diagnose Helicobacter pylori infection of the stomach. The procedure measures radioactive carbon dioxide in exhaled breath to detect bacterial urease activity.
Service Type: Noninvasive diagnostic breath test
Typical Site of Service: Clinical laboratory or outpatient diagnostic facility, often performed in hospital outpatient departments, ambulatory surgical centers with laboratory services, or dedicated outpatient testing centers.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient with a several-week history of dyspepsia, epigastric discomfort, and intermittent nausea is evaluated in an outpatient gastroenterology clinic. After a clinical assessment and review of prior medications, the clinician determines noninvasive testing for Helicobacter pylori is appropriate. The patient is asked to fast, then ingests a C-14 labeled urea capsule or solution in clinic. Breath samples are collected at prescribed intervals (typically baseline and at 10–30 minutes post ingestion) into capture devices. The samples are transported immediately to the laboratory. A nuclear medicine technologist or trained laboratory technologist analyzes the breath samples using a scintillation counter to detect radioactive C-14 labeled CO2, indicating urease activity from H. pylori. Results are reported to the ordering gastroenterologist for diagnosis and management planning. Typical site of service is an outpatient clinic, gastroenterology office, or hospital outpatient laboratory performing nuclear medicine breath testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default when no specific modifier applies |
52 | Reduced services |