Update to Claims Logic: CAM 20406 Testing for Diagnosis of Helicobacter Pylori (1404)

Update to Claims Logic: CAM 20406 Testing for Diagnosis of Helicobacter Pylori

5/22/2019

Effective Aug. 15, 2019, BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan will no longer reimburse CPT 83009 and 86677 in accordance with the medical policy, Testing for Diagnosis of Helicobacter Pylori.

We have recently reviewed the medical policy and how the claims system applies benefits for CPT 83009 and 86677. Urea breath testing or stool antigen testing for Helicobacter Pylori infection is appropriate; however, serologic testing is not medically necessary. The claims system has been allowing reimbursement for these codes contrary to the medical policy. The system will be updated to disallow reimbursement for these codes beginning Aug. 15, 2019. Refunds will not be requested for dates of service already allowed. 

If you have questions about this bulletin, please contact Provider Education by submitting the Provider Education Contact Form or by calling 803-264-4730 and a knowledgeable education specialist will respond.