RetiredBlue Cross Blue Shield - OklahomaPolicy CPCPLAB026

Fecal Calprotectin Testing in Adults

This clinical payment and coding policy governs reimbursement criteria for fecal calprotectin testing for adults (age 18+) and indicates situations when testing may or may not be reimbursable for Blue Cross and Blue Shield of Oklahoma members.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyFecal Calprotectin Testing in Adults

Policy CodePolicy CPCPLAB026

Change TypeArchivedage applicability and reimbursement criteria clarified

Effective DateOct 3, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional records upon request for claim review.

SourceLink

POLICY UPDATE CHANGES

Document archived and information moved to CPCPLAB035 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease.

Added a note indicating this policy is specific to individuals 18 years of age or older; criteria do not apply to individuals less than 18 years of age.

Reimbursement information revised to clarify when fecal calprotectin testing may be reimbursable (differential diagnosis between noninflammatory and inflammatory GI disease; assess response to therapy/monitor relapse in IBD) and to state other uses are not reimbursable.

18+age group this policy applies to

3reimbursement positions

CPCPLAB026policy identifier

01/02/2026archive date

Reimbursement Criteria for Adults (18+)

Adult fecal calprotectin reimbursement criteria

Reimbursement positions for individuals 18 years of age or older:

NOTE: This policy is specific to individuals 18 years of age or older. Criteria below do not apply to individuals less than 18 years of age.

Reimbursable indications

Fecal calprotectin testing for the differential diagnosis between noninflammatory gastrointestinal disease (e.g., IBS) and inflammatory gastrointestinal disease (e.g., IBD) may be reimbursable.
Fecal calprotectin testing to assess for response to therapy, to detect relapse, or to monitor gastrointestinal conditions such as inflammatory bowel disease (IBD) may be reimbursable.

Not reimbursable: Fecal calprotectin testing for all other situations not discussed above is not reimbursable.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyFecal Calprotectin Testing in Adults

Policy CodePolicy CPCPLAB026

Change TypeArchivedage applicability and reimbursement criteria clarified

Effective DateOct 3, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional records upon request for claim review.

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.

Procedure Codes and Coding Standards

Procedure codes (not exhaustive)mixed

Procedure codes referenced but not enumerated in policy; inclusion does not guarantee coverage.

Coding standards

Coding standardsClaims must be coded using HIPAA‑approved code sets and industry standard coding guidelines (eg, CPT, HCPCS, ICD‑10, UB, NDC, DRG, CMS NCCI) as described by the policy.

Provider responsibilityProviders are responsible for submission of accurate documentation of services performed and expected to submit claims using valid code combinations from HIPAA‑approved code sets.

Code edit and claim reviewClaims are subject to code edit protocols and claim review, including benefit terms, provider contracts, medical policies, and coding software logic; additional documentation may be requested.

Industry referencesGuidance includes Uniform Billing Editor, AMA CPT and CPT Assistant, HCPCS, ICD‑10‑CM/PCS, NDC, DRG guidelines, and CMS NCCI policy manual and table edits.

Documentation, Claims, and Provider Responsibilities

Documentation Required

Documentation, coding, and claim review requirements

Providers must submit accurate documentation of services performed, code claims using valid HIPAA-approved code sets and industry coding guidelines, and be prepared to provide additional documentation upon request. Claims are subject to code edit protocols and claim review against benefit terms, provider contracts, medical policies, and coding logic.

Submit claims using valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, etc.).
Code claims according to industry standard coding guidelines (Uniform Billing, AMA CPT, CMS NCCI, CCI edits, etc.).
Claims are subject to code edit protocols and claim review; providers may be urged to submit additional documentation upon request.

Definitions and Plan Documents

Fecal calprotectin testing

DefinitionFecal calprotectin testing is a stool biomarker test used to differentiate inflammatory versus noninflammatory gastrointestinal disease and to monitor IBD activity or relapse in adults.

Reimbursable indication — differential diagnosisMay be reimbursable when used to distinguish noninflammatory GI disease (eg, IBS) from inflammatory GI disease (eg, IBD).

Reimbursable indication — monitoringMay be reimbursable to assess response to therapy, detect relapse, or monitor conditions such as inflammatory bowel disease (IBD).

Non‑reimbursable useNot reimbursable for situations other than the differential diagnosis or monitoring/therapy response/relapse assessment described above.

Plan documents

Included documentsPlan documents include Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

Plan documents governIf a conflict exists between this policy and a member's plan document, the plan document will govern.

Provider contracts governIf a conflict exists between this policy and a provider contract, the provider contract will govern.

Discretion and authorityBCBSOK may use reasonable discretion interpreting and applying this policy and has full and final discretionary authority to the extent provided under applicable plan documents.