CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABO2S

Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

Defines BCBSNM reimbursement criteria and coding guidance for fecal analysis and testing related to diagnosis of intestinal dysbiosis and pre-FMT screening; applies to providers submitting claims to Blue Cross Blue Shield of New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyFecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

Policy CodePolicy CPCPLABO2S

Change TypeClarified (no material change)

Effective DateNov 1, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and claims using valid HIPAA-approved code sets and review individual plan documents for coverage.

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review; reimbursement information unchanged.

Version 1.0policy version

Nov 1, 2023plan effective date

Specific listreimbursable organisms

Multiplenon-reimbursable items

Reimbursement Criteria and Exclusions

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyFecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

Policy CodePolicy CPCPLABO2S

Change TypeClarified (no material change)

Effective DateNov 1, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and claims using valid HIPAA-approved code sets and review individual plan documents for coverage.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Reimbursement criteria and exclusions

Covered or excluded items for fecal analysis and pre–fecal microbiota transplant (FMT) testing are described below. Reimbursement may apply only for the specific organisms/tests listed; other diagnostic fecal components and unlisted organism NAATs are excluded.

ALL of the following

ANY of the following
- Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae
- Vancomycin-resistant Enterococci (VRE)
- Carbapenem-resistant Enterobacteriaceae (CRE)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Campylobacter
- Shigella
- Salmonella

ALL of the following

ANY of the following
- Clostridium difficile
- Campylobacter
- Salmonella
- Shigella
- Shiga toxin–producing Escherichia coli
- Norovirus

Exclusion - NAAT not reimbursable

ANY of the following
- Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae
- Vancomycin-resistant Enterococci (VRE)
- Carbapenem-resistant Enterobacteriaceae (CRE)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Other microorganisms not listed as reimbursable above

Exclusion - Diagnostic fecal components not reimbursable

ANY of the following
- Identification and quantitation of fecal yeast (including Candida albicans, C. tropicalis, Rhodotorula and Geotrichum)
- Levels of Lactobacilli, bifidobacteria, Escherichia coli and other detailed microbiome panels (including Aeromonas, Bacillus cereus, Campylobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella, S. aureus, Vibrio)
- Triglycerides
- Chymotrypsin
- Meat and vegetable fibers

Billing note

Example codes included in the policy: 82542, 82705, 82710, 82715, 83986, 84311, 87045, 87046, 87075, 87076, 87077, 87081, 87102, 87106, 87493, 87500, 87641, 87798, 89160, S3708

Procedure Codes and Coding Notices

Example procedure codes referencedmixed

82542	82542
82705	82705
82710	82710
82715	82715
83986	83986
84311	84311
87045	87045
87046	87046
87075	87075
87076	87076

1–10 of 20

1/2

Covered CPT/HCPCS (examples) - subset highlighted in briefmixed

82542	Fecal fat; quantitative
82705	Fecal occult blood
87045	Culture, bacterial; stool
87493	Infectious agent detection by nucleic acid (e.g., NAAT)
89160	Fecal antigen test
S3708	Stool culture, FMT donor screening (HCPCS example)

Code list completeness notice

Code list scopeThe provided procedure code list is not all-encompassing; inclusion of a code does not guarantee it is a covered service or eligible for reimbursement.

Example codes shownSample codes included in the document: 82542, 82705, 87045, 87493, 89160, S3708 (partial list)

Coding systemList contains mixed code systems (CPT, HCPCS) and is illustrative rather than exhaustive.

Claims Submission and Review Expectations

Documentation Required

Claims submission and review expectations

Providers must submit accurate documentation of services performed and submit claims using valid code combinations from HIPAA‑approved code sets. Claims are subject to code edit protocols and may be reviewed against benefit terms, provider contracts, medical policies, and coding software logic; upon request, providers should supply any additional documentation. Review individual plan documents for product‑specific lab management reimbursement criteria and eligibility.

Submit claims using valid HIPAA‑approved code sets (e.g., CPT, HCPCS, ICD‑10, NDC) and follow standard coding guidelines.
Claims are subject to code edit protocols and review for coverage, contract terms, medical policies, and coding logic.
Be prepared to provide additional documentation upon request.
Review the member’s plan documents for product‑specific reimbursement rules and eligibility.

Reimbursable and Non-reimbursable Test Components

Reimbursable organisms/components

Reimbursable culture targets (pre-FMT)May be reimbursable: ESBL-producing Enterobacteriaceae; Vancomycin-resistant Enterococci (VRE); Carbapenem-resistant Enterobacteriaceae (CRE); Methicillin-resistant Staphylococcus aureus (MRSA); Campylobacter; Shigella; Salmonella.

Reimbursable NAAT targets (pre-FMT)May be reimbursable: Clostridium difficile; Campylobacter; Salmonella; Shigella; Shiga toxin-producing Escherichia coli; Norovirus; Rotavirus; SARS-CoV-2 (COVID-19).

NAAT targets not reimbursable (examples)NAAT for ESBL-producing Enterobacteriaceae, VRE, CRE, MRSA and other microorganisms not listed above are not reimbursable.

Non-reimbursable tests/components

Non-reimbursable stool components (metabolites & enzymes)Triglycerides; Chymotrypsin; Long-chain fatty acids; Cholesterol; N-butyrate; Beta-glucuronidase; Total short chain fatty acids and short chain fatty acid distribution are not reimbursable for evaluation of dysbiosis, IBS, malabsorption, or SIBO.

Non-reimbursable microbial/quantitation panelsIdentification and quantitation of fecal yeast (e.g., C. albicans, C. tropicalis, Rhodotorula, Geotrichum) and detailed levels of Lactobacilli, Bifidobacteria, E. coli and other extensive microbiome panel components are not reimbursable.

Non-reimbursable additional componentsMeat and vegetable fibers; iso-butyrate, iso-valerate, n-valerate; fecal pH; fecal secretory IgA are listed as non-reimbursable diagnostic components.