CPT 78267 is referenced in 3 tracked payer policy changes from Texas Medicaid and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 78267 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
TMHP has updated CLIA laboratory certification requirements for 23 procedure codes, effective June 30, 2026. Beginning June 30, 2024, TMHP may reprocess historical claims (back to that date) for these codes, potentially resulting in additional payments or recoupments on future R&S reports. Your practice must ensure all laboratory service providers have current CLIA certifications submitted in PEMS.
Aetna considers FDA-cleared carbon isotope (13C or 14C) urea breath testing and stool antigen testing (HpSA) medically necessary for active Helicobacter pylori infection in selected persons, including adults with idiopathic thrombocytopenic purpura, persons before bariatric surgery, persons before starting proton pump inhibitor therapy for dyspepsia, and persons taking long term, low-dose aspirin or initiating chronic NSAID treatment. Nucleic acid amplification for clarithromycin resistance testing is medically necessary for selecting salvage regimens for treatment-experienced individuals with persistent H. pylori infection. H. pylori serology, the AmHPR panel, IL-1B and TNFA gene polymorphism testing, and urea breath or stool antigen testing for other indications such as stroke risk, dementia risk and screening of asymptomatic persons are considered experimental, investigational or unproven.
Aetna's Clinical Policy Bulletin 0390 sets the coverage rules for diagnosing smell and taste disorders. Aetna considers the following medically necessary for members with unexplained olfactory dysfunction or gustatory dysfunction: biopsy of the olfactory mucosa, drug assays and chemical analyses, electroencephalography for members with a history of seizures, hematological tests, medical evaluation, nasal endoscopy, CT or MRI to rule out an intracranial or peripheral nerve abnormality, neurological, otolaryngological and psychiatric consultation, standard taste tests, and standardized olfactory tests such as the University of Pennsylvania Smell Identification Test or Sniffin' Sticks. An initial visit and a follow-up visit are considered medically necessary for smell and taste testing, and additional visits for testing are considered not medically necessary. Aetna considers cerebrospinal fluid SARS-CoV-2 antibody testing, electrogustometry, TAS2R38 gene genotyping, MRI for COVID-19 olfactory dysfunction, nasal nitric oxide measurement, olfactometry, olfactory and gustatory event potentials, PET, rhinomanometry, rhinometry, SPECT, and H. pylori tests experimental, investigational or unproven for diagnosing these disorders.
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