CurrentUnitedHealthcarePolicy 2025R8005A

Fecal calprotectin test reimbursement

Defines UnitedHealthcare reimbursement policy for fecal calprotectin testing (CPT/HCPCS code 83993) for Commercial and Individual Exchange plans; applies to claims billed on CMS 1500 and UB04 forms.

Policy Summary

PayerUnitedHealthcare

PolicyFecal calprotectin test reimbursement

Policy CodePolicy 2025R8005A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionReimbursement will be considered when fecal calprotectin testing is billed using procedure code 83993 for the listed conditions; not reimbursed for other conditions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1procedure code listed

2condition categories eligible

1applicable plan type (Individual Exchange)

Reimbursable Indications for Fecal Calprotectin

Reimbursable indications

UnitedHealthcare will consider reimbursement for fecal calprotectin testing when billed with the specified procedure code for the following clinical scenarios:

ALL of the following

Procedure code
- Procedure code 83993 is billed for fecal calprotectin testing
Clinical indication (ONE of)
- Non-inflammatory gastrointestinal disease (e.g., irritable bowel syndrome [IBS])
- Inflammatory gastrointestinal disease (e.g., inflammatory bowel disease [IBD])

ALL of the following

Policy Summary

PayerUnitedHealthcare

PolicyFecal calprotectin test reimbursement

Policy CodePolicy 2025R8005A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionReimbursement will be considered when fecal calprotectin testing is billed using procedure code 83993 for the listed conditions; not reimbursed for other conditions.

SourceLink

On This Page

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.

Reimbursement Rules and Provider Billing Guidance

Billing Rule

Bill code 83993 only for IBS or IBD indications; other uses not reimbursed

Reimbursement is limited to claims billed with CPT code 83993 and only when the test is ordered for non‑inflammatory gastrointestinal disease (e.g., IBS) or inflammatory gastrointestinal disease (e.g., IBD). Claims for fecal calprotectin billed with code 83993 for any other condition will not be considered for reimbursement.

Bill using procedure code 83993 (Fecal calprotectin test).
Ensure the indication is either non‑inflammatory GI disease (e.g., IBS) or inflammatory GI disease (e.g., IBD).
Do not bill 83993 for conditions not listed; such claims will not be considered for reimbursement.

OpenPayer

Fecal calprotectin test reimbursement

Reimbursable Indications for Fecal Calprotectin

Procedure and Billing Codes

Reimbursement Rules and Provider Billing Guidance

Condition Examples and Definitions