CurrentUnitedHealthcarePolicy 2025R8202B

Fecal analysis reimbursement for intestinal disorders

Defines UnitedHealthcare Medicare Advantage reimbursement stance and methodology for fecal analysis testing billed on UB04/CMS 1500 forms for evaluation of intestinal dysbiosis, IBS, malabsorption, or small intestinal bacterial overgrowth; applies to Medicare Advantage plans and network providers.

Policy Summary

PayerUnitedHealthcare

PolicyFecal analysis reimbursement for intestinal disorders

Policy CodePolicy 2025R8202B

Change TypeLanguage and code update

Effective Date

Next Review Date

Key ActionDo not submit claims for the listed fecal analysis procedure codes for evaluation of intestinal dysbiosis, IBS, malabsorption, or SIBO for UnitedHealthcare Medicare Advantage.

SourceLink

POLICY UPDATE CHANGES

Policy language and code update in Reimbursement Guidelines section.

Policy implemented by UnitedHealthcare Medicare Advantage.

Policy published on 9/01/2025.

11listed fecal analysis components

13procedure code entries

1policy number

Coverage Determinations

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.

Not covered fecal analysis testing

UnitedHealthcare will not consider reimbursement for the following diagnostic testing procedure codes for fecal analysis in suspected or determined intestinal dysbiosis, irritable bowel syndrome (IBS), malabsorption, or small intestinal bacterial overgrowth (SIBO).

ALL of the following

Not covered procedure codes
- 82542
- 82542, 1 = 82705
- 82542, 2 = 82710
- 82542, 3 = 82715
- 82542, 4 = 83986
- 82542, 5 = 84311
- 87076
- 87076, 1 = 87077
- 87076, 2 = 87102
- 87076, 3 = 87106
- 87076, 4 = 89160
- 87076, 5 = S3708

These procedure codes are listed for fecal analysis and are not considered for reimbursement when billed for evaluation of suspected or determined intestinal dysbiosis, IBS, malabsorption, or small intestinal bacterial overgrowth.

Procedure Codes and Reimbursement Stance

Fecal analysis procedure codes listed in policymixedNot Covered

82542	Stool, enzyme/chemical analysis (listed with multiple mappings in policy)
82705	(mapped as 82542, 1 = 82705)
82710	(mapped as 82542, 2 = 82710)
82715	(mapped as 82542, 3 = 82715)
83986	(mapped as 82542, 4 = 83986)
84311	(mapped as 82542, 5 = 84311)
87076	Culture, bacteria (mapped with multiple equals)
87077	(mapped as 87076, 1 = 87077)
87102	(mapped as 87076, 2 = 87102)
87106	(mapped as 87076, 3 = 87106)

1–10 of 12

1/2

Reimbursement stance for listed fecal analysis codes

Reimbursement stanceNot considered for reimbursement for the listed fecal analysis procedure codes when used to evaluate suspected or determined intestinal dysbiosis, irritable bowel syndrome (IBS), malabsorption, or small intestinal bacterial overgrowth (SIBO).

Applicable settingsApplies to diagnostic testing procedure codes for fecal analysis billed for the above indications as referenced in this policy.

Code list referenceSee policy procedure code listings for specific CPT/HCPCS mappings that are not considered for reimbursement.

ScopeUnitedHealthcare Medicare Advantage reimbursement policy—billing on UB04 and CMS 1500 forms.

Billing, Forms, and Applicability

Prior Authorization

Applicability and prior authorization note

This reimbursement policy applies to UnitedHealthcare Medicare Advantage Plans and to services billed on UB04 (CMS 1450) and CMS 1500 forms. UnitedHealthcare Medicare Advantage reimbursement policies do not include notations regarding prior authorization requirements and may be modified to comply with CMS or coding guideline changes.

Providers are responsible for submission of accurate claims and must bill using the code(s) that correctly describe the services provided.
UnitedHealthcare Medicare Advantage may modify this policy at any time by publishing a new version to comply with CMS or national coding guideline changes.
This policy applies to services reported on UB04 and CMS 1500 forms (or their electronic equivalents).

Test Components and Purpose

Fecal analysis components and purpose

Included test componentsTriglycerides; Chymotrypsin; Long chain fatty acids; Cholesterol; Total short chain fatty acids; N-butyrate; Short chain fatty acid distribution; Beta-glucuronidase; pH; Fecal secretory IgA; Meat and vegetable fibers.

Microbiology targetsQuantification of Lactobacilli, Bifidobacteria, E. coli and other potential bacterial pathogens (including Aeromonas, Bacillus cereus, Campylobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella, Staphylococcus aureus, Vibrio).

Yeast analysisIdentification and quantitation of fecal yeast (including Candida albicans, Candida tropicalis, Rhodotorula, and Geotrichum).

PurposeFecal analysis is performed for evaluation of intestinal dysbiosis, irritable bowel syndrome (IBS), malabsorption, or small intestinal bacterial overgrowth (SIBO).