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Serologic Testing for Helicobacter Pylori

Blue Cross & Blue Shield of Mississippi·MS · Gastroenterology, Family Medicine, Internal Medicine·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

This policy establishes coverage guidelines for H. pylori serologic testing, specifying that one test is medically necessary for initial workup of dyspepsia, gastric/duodenal ulcers, and certain gastric conditions, but not medically necessary for previously treated patients or asymptomatic screening. The policy was reviewed on 03/26/2025 with no changes.

Action Required

Action needed
Billing team should verify that H. pylori serologic testing (CPT 86677) is only billed for appropriate indications including initial workup of dyspepsia, active gastric/duodenal ulcers, documented ulcer history, post-gastric cancer resection, and low-grade gastric MALT lymphoma. Do not bill for patients previously treated for H. pylori infection or for screening asymptomatic patients as these are considered not medically necessary and may result in claim denials.

Affected Billing Codes

86677
C16.0
C16.9
C83.80
C83.89
C88.40
K25.0
K25.9
K26.0
K26.9
K27.0
K27.9
K29.00
K29.91
K52.81
K30
R68.81