CurrentColorado Rocky Mountain Health PlansPolicy 2025R8205A

UnitedHealthcare Medicare Advantage Reimbursement Policy — Fecal Calprotectin Testing (CMS 1500 / UB04)

Defines UnitedHealthcare Medicare Advantage reimbursement methodology for fecal calprotectin testing billed on CMS 1500 or UB04 forms for Medicare Advantage enrollees and network providers.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyUnitedHealthcare Medicare Advantage reimbursement for fecal calprotectin testing

Policy CodePolicy 2025R8205A

Change TypeNew policy

Effective DateSep 1, 2025

Next Review Date

Key ActionSubmit accurate claims on UB04 (CMS1450) or CMS1500 forms; no prior authorization notations are included.

SourceLink

POLICY UPDATE CHANGES

New Policy.

1Procedure code listed

2Condition categories covered

CMS1500/UB04Forms governed

Medicare AdvantageApplicable plan

Reimbursement Coverage Criteria

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Coverage criteria

UnitedHealthcare will consider reimbursement when the fecal calprotectin CPT code is billed for the following conditions.

ALL of the following

ONE of the following diagnoses
- Non-inflammatory gastrointestinal disease (e.g., IBS)
- Inflammatory gastrointestinal disease (e.g., IBD)

Procedure Codes and Allowed Conditions

Fecal calprotectin procedure codeCPTCovered

83993

Fecal calprotectin

Allowed conditions

Allowed conditionsReimbursement considered when fecal calprotectin testing is billed for non-inflammatory gastrointestinal disease (e.g., IBS) or inflammatory gastrointestinal disease (e.g., IBD).

Non-inflammatory exampleIrritable bowel syndrome (IBS).

Inflammatory exampleInflammatory bowel disease (IBD).

ExclusionsUnitedHealthcare will not consider reimbursement of the fecal calprotectin procedure code for conditions other than the two categories listed.

Claims Submission and Provider Responsibilities

Documentation Required

Submit accurate claims on UB04 (CMS1450) or CMS1500; prior auth notations not included

You are responsible for submission of accurate claims on UB04 (CMS 1450) and CMS 1500 forms; ensure the codes billed correctly describe the services provided. This policy does not include notations regarding prior authorization requirements, and UnitedHealthcare Medicare Advantage may use reasonable discretion in interpreting and applying the policy.

Submit claims on UB04 (CMS 1450) or CMS 1500 forms (or electronic equivalent).
Bill the CPT/CMS code(s) that correctly describe the health care services provided.
Be aware the policy does not list prior authorization requirements and UnitedHealthcare Medicare Advantage may exercise discretion in application.

Definitions and Reimbursement Guidelines

Reimbursement Guidelines

Reimbursement methodologyDescribes UnitedHealthcare Medicare Advantage reimbursement methodology for fecal calprotectin testing, including coding and claims submission considerations.

Applicable formsPolicy governs claims billed on UB04 (CMS1450) and CMS1500 forms.

Coding reference noteProcedure codes in the policy are provided as a general reference and may not be all-inclusive.

Covered conditions

Covered condition — non-inflammatoryNon-inflammatory gastrointestinal disease (example: IBS).

Covered condition — inflammatoryInflammatory gastrointestinal disease (example: IBD).

ScopeReimbursement considered only when the fecal calprotectin CPT code is billed for the listed condition categories; other conditions are not covered.