CurrentColorado Rocky Mountain Health PlansPolicy N/A

Fecal analysis reimbursement

This reimbursement policy governs payment for fecal analysis testing for evaluation of intestinal dysbiosis, IBS, malabsorption, or small intestinal bacterial overgrowth for UnitedHealthcare Community Plan Medicaid products and applies to services billed on UB-04 or CMS-1500 forms.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyFecal analysis reimbursement

Policy CodePolicy N/A

Change TypeState exceptions added / policy version updated

Effective DateN/A

Next Review DateN/A

Key ActionDo not expect reimbursement for specified fecal analysis procedure codes when used for suspected or confirmed intestinal dysbiosis, IBS, malabsorption, or SIBO; submit accurate claims using correct CPT/CMS coding.

SourceLink

POLICY UPDATE CHANGES

State Exceptions: Added Pennsylvania.

Policy Version Change — State Exceptions updated.

Policy implemented by UnitedHealthcare Community & State.

>=13fecal analysis components listed

11+states explicitly listed as exempt from policy

7history entries / dates noted

Coverage and Non-covered Services

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.

Non-covered procedures and state exceptions

UnitedHealthcare will not consider reimbursement for the diagnostic testing procedure codes listed below for fecal analysis when performed for suspected or confirmed intestinal dysbiosis, irritable bowel syndrome (IBS), malabsorption, or small intestinal bacterial overgrowth (SIBO). Some state Medicaid programs are exempt or have differing allowable codes.

UnitedHealthcare will not consider reimbursement for the following diagnostic testing procedure codes for fecal analysis when performed for suspected or confirmed intestinal dysbiosis, IBS, malabsorption, or SIBO.

Procedure codes not considered for reimbursement

82542
82705
82710
82715
83986
84311
87076
87077
87102
87106
89160
S3708

State exceptions / allowable codes

Arizona is exempt from this policy.
Colorado is exempt from this policy.
Idaho is exempt from this policy.
Indiana is exempt from this policy.
Kansas is exempt from this policy.
Kentucky is exempt from this policy.
Maryland is exempt from this policy.

Providers must follow applicable state Medicaid program guidance where exemptions or differing allowable codes apply; billing should reflect the state-specific allowed codes and UnitedHealthcare claims policies.

Procedure Codes and State-Specific Allowables

Procedure codes not considered for reimbursementmixedNot Covered

82542	Stool analysis; multiple reagent tests (listed mapping to other codes in document)
82705	Triglycerides; fecal
82710	Chymotrypsin; fecal
82715	Fatty acids; fecal
83986	Short chain fatty acids; fecal
84311	Fecal fats; qualitative/quantitative
87076	Culture; feces
87077	Culture; feces, isolated organism ID
87102	Smear/special stain, fecal
87106	Identifications, fungi/yeast

1–10 of 12

1/2

Pennsylvania — Allowable codes (PA DHS)

PA DHS allowable CPT/HCPCS codes82542, 82705, 87210, 83986, 87076, 87077, 87102

ScopeCodes listed are allowable per Pennsylvania Department of Human Services (PA DHS) fee schedule as state exception to this policy.

UseThese codes represent fecal diagnostic tests and cultures that may be reimbursed in Pennsylvania despite the policy's non‑coverage stance elsewhere.

Billing, Prior Authorization, and Denial Guidance

Denial Risk

Prior authorization / denial risk: non‑reimbursable fecal analysis codes

UnitedHealthcare will not consider reimbursement for the specified diagnostic fecal analysis procedure codes when performed for suspected or determined intestinal dysbiosis, irritable bowel syndrome, malabsorption, or small intestinal bacterial overgrowth; providers are responsible for submitting accurate claims using CPT/CMS coding guidelines.

Do not expect payment for the listed fecal analysis procedure codes when used for evaluation of intestinal dysbiosis, IBS, malabsorption, or SIBO — submitting such codes may result in claim denial.
Ensure claims use CPT/CMS coding guidelines and accurately reflect the services provided; UnitedHealthcare Community Plan holds providers responsible for correct claim submission.

Definitions and Test Components

Fecal analysis — Intended use

Intended useEvaluation of intestinal dysbiosis, irritable bowel syndrome (IBS), malabsorption, or small intestinal bacterial overgrowth (SIBO).

SettingReimbursement policy applies to UnitedHealthcare Community Plan Medicaid products; services billed on UB‑04 or CMS‑1500 forms.

PurposeTo guide payment methodology and determine when fecal analysis procedures are considered for reimbursement under the policy.

Fecal analysis — Components

Core components testedTriglycerides; 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.

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

Fungal/yeast identificationIdentification and quantitation of fecal yeast, including Candida albicans, C. tropicalis, Rhodotorula and Geotrichum.