Summary & Overview
CPT 83630: Stool Lactoferrin Qualitative Test
CPT code 83630 denotes a qualitative stool assay for lactoferrin, an established biomarker of intestinal inflammation. The code captures the technical laboratory procedure in which a lab analyst tests a stool specimen to determine the presence or absence of lactoferrin. This test is clinically relevant for differentiating inflammatory from noninflammatory gastrointestinal conditions and can impact diagnostic pathways nationally.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the kinds of benchmarking and payer coverage topics commonly associated with this laboratory service. The publication outlines common modifiers and operational considerations when billing this test and highlights where data is available versus not provided.
The article provides practical policy and billing context rather than clinical guidance, summarizing why CPT code 83630 matters for laboratories, clinicians ordering stool inflammatory testing, and payer coverage workflows. Data not available in the input is noted where relevant.
Billing Code Overview
CPT code 83630 describes a qualitative laboratory test for lactoferrin performed on a stool specimen to detect intestinal inflammation. The service involves a laboratory analyst conducting the technical component of the assay to determine presence or absence of lactoferrin as an inflammatory marker.
Service Type: Laboratory — Qualitative Stool Assay
Typical Site of Service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient gastroenterology clinic or urgent care with new or worsening diarrhea, abdominal pain, or suspected inflammatory bowel disease (IBD) flare. The clinician orders a stool lactoferrin qualitative assay to detect intestinal inflammation as part of an initial workup or to distinguish inflammatory from noninflammatory causes of diarrhea. A stool specimen is collected by the patient or staff, transported to the laboratory, and logged by the accessioning technologist. The laboratory analyst performs the qualitative test 83630 on the stool specimen and documents the qualitative result (positive or negative for lactoferrin). The interpreted result is transmitted to the ordering clinician and entered into the medical record to inform decisions such as need for fecal calprotectin, stool culture, Clostridioides difficile testing, endoscopic evaluation, or escalation of anti-inflammatory therapy for patients with known IBD.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the professional interpretation if separated from the technical lab work (rare for this technical-only stool assay). |
TC |