Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing
This policy governs reimbursement criteria for fecal analysis used in diagnosing intestinal dysbiosis and testing of donor stool prior to fecal microbiota transplantation (FMT) for members covered by Blue Cross and Blue Shield of Texas; applicability may vary by product and plan documents. Providers must follow coding and documentation requirements when submitting claims.
Edited #1, #2, #3 to clarify that fecal microbiota transplantation testing is on the sample coming from the donor.
#4.h edited for clarity.
Added codes 87076, 87077, 87081, 87106 to the reimbursement code list.
Removed codes 82239, 82725, 82784, 83520, 83630, 87177, 87209, 87328, 87329, 87336 from the reimbursement code list.
Document updated with literature review and references revised.
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