CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB025

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

Defines reimbursement criteria for laboratory testing of donor stool prior to fecal microbiota transplantation (FMT) and for fecal analyses used to evaluate intestinal dysbiosis and related conditions; applies to Blue Cross Blue Shield of Oklahoma providers and products, with some requirements varying by product.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

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

Policy CodePolicy CPCPLAB025

Change TypeClarified (non‑material) — literature reviewhistorical code edits

Effective DateJan 3, 2026

Next Review DateN/A

Key ActionSubmit accurate documentation and bill using valid HIPAA‑approved code sets; claims may be reviewed and require additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review. Reimbursement Information unchanged.

Edited prior reimbursement items and codes in past updates (history lists specific code additions/removals and clarifications that apply to donor sample testing).

15not reimbursable diagnostic tests listed

8reimbursable by NAAT (microorganisms)

7reimbursable by culture (microorganisms)

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 enumerated

Coverage Criteria — FMT Donor Testing & Diagnostic Fecal Analysis

Coverage criteria for FMT donor testing and diagnostic fecal analysis

Reimbursement determinations for tests on donor stool prior to fecal microbiota transplantation (FMT) and for diagnostic fecal analyses used to evaluate intestinal dysbiosis, IBS, malabsorption, or small intestinal bacterial overgrowth.

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
- Clostridioides difficile
- Campylobacter
- Salmonella
- Shigella
- Shiga toxin-producing Escherichia coli
- Norovirus

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)
- Any other microorganisms not listed as reimbursable above

ALL of the following

ANY of the following
- Triglycerides
- Chymotrypsin
- Iso-butyrate, iso-valerate, and n-valerate
- Meat and vegetable fibers
- Long chain fatty acids
- Cholesterol

ALL of the following

Providers must submit claims using valid HIPAA‑approved code sets and follow industry standard coding guidelines; claims are subject to review, code edit protocols, and may require additional documentation.
Not all lab management reimbursement requirements apply to every product; providers should review specific plan documents and provider contracts to determine eligible coverage.

Procedure and Diagnostic Codes

Procedure/diagnostic codes referencedmixed

82542
82705
82710
82715
83986
84311
87045
87046
87075
87076

1–10 of 20

1/2

Code list completeness note

Scope of code listThe procedure code list provided is explicitly stated as not all-encompassing; it does not include every possible code related to fecal analysis or FMT testing.

No coverage guaranteeInclusion of a code in the list does not guarantee that the code is a covered service or eligible for reimbursement.

Provider responsibilityProviders should verify coverage and applicable billing rules against specific plan documents and provider contracts before submission.

Use of valid code setsClaims must be submitted using valid HIPAA‑approved code sets and follow industry standard coding guidelines (see Provider Actions).

Claims Submission & Documentation Requirements

Documentation Required

Claims submission and documentation requirements

Providers must submit accurate documentation of services performed and bill using valid HIPAA‑approved code sets (e.g., CPT, HCPCS, ICD‑10, NDC) in accordance with industry standard coding guidelines. Claims are subject to code edit protocols and review against benefit coverage, provider contract terms, medical policies, and coding software logic; upon request, providers should supply additional documentation.

Use valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, NDC, DRG rules).
Code claims according to industry standards (Uniform Billing, AMA CPT guidance, CMS NCCI edits).
Be prepared to provide additional documentation when requested during claim review.

Definitions — FMT and Diagnostic Fecal Analysis

FMT donor testing definition

DefinitionLaboratory analyses performed on donor fecal samples prior to donation for fecal microbiota transplantation (FMT).

PurposeTo screen donor stool for specific microorganisms (by bacterial culture or NAAT) to reduce risk of transmitting infectious agents via FMT.

Examples of tested targetsMay include organisms listed as reimbursable for donor screening such as C. difficile, Campylobacter, Salmonella, Shigella, Shiga toxin–producing E. coli, Norovirus, Rotavirus, SARS‑CoV‑2, and select organisms by culture (ESBL, VRE, CRE, MRSA).

Billing implicationReimbursement determinations apply when testing is performed on donor fecal samples; verify coverage per plan documents and coding guidance.

Diagnostic fecal analysis definition

Definition

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

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

Policy CodePolicy CPCPLAB025

Change TypeClarified (non‑material) — literature reviewhistorical code edits

Effective DateJan 3, 2026

Next Review DateN/A

Key ActionSubmit accurate documentation and bill using valid HIPAA‑approved code sets; claims may be reviewed and require additional documentation upon request.

SourceLink

On This Page

SARS-CoV-2 (COVID-19)

Total short chain fatty acids

Quantification of Lactobacilli, bifidobacteria, and E. coli and other 'potential pathogens' (including Aeromonas, Bacillus cereus, Campylobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella, S. aureus, Vibrio)

Identification and quantitation of fecal yeast (including C. albicans, C. tropicalis, Rhodotorula and Geotrichum)

Beta‑glucuronidase

Short chain fatty acid distribution

Fecal tests and component analyses that are purported to evaluate intestinal dysbiosis, irritable bowel syndrome (IBS), malabsorption, or small intestinal bacterial overgrowth (SIBO).

Examples of non‑reimbursable diagnostic componentsIncludes triglycerides; chymotrypsin; iso‑butyrate, iso‑valerate, n‑valerate; meat and vegetable fibers; long chain fatty acids; cholesterol; total short chain fatty acids; N‑butyrate; beta‑glucuronidase; pH; short chain fatty acid distribution; fecal secretory IgA.

Examples of non‑reimbursable microbiology/quantificationQuantification of Lactobacilli, bifidobacteria, E. coli and other 'potential pathogens' (Aeromonas, Bacillus cereus, Campylobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella, S. aureus, Vibrio); identification and quantitation of fecal yeast (C. albicans, C. tropicalis, Rhodotorula, Geotrichum).

Coverage stanceThese diagnostic fecal component analyses are specified as not reimbursable when used to evaluate dysbiosis, IBS, malabsorption, or SIBO; providers should follow plan-specific coverage rules.