CommercialCoverageMedium impact
Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)
Aetna·Gastroenterology, Internal Medicine, Family Medicine +3 more·Medical Policy
Effective date
Mar 20, 2026
We identified it
Aug 17, 2026
Summary
Aetna's H. pylori testing policy (CPB 0177) clarifies which testing methods are covered for specific clinical indications and explicitly designates certain tests as experimental/investigational. Billing teams must ensure claims only include covered CPT codes (urea breath test, stool antigen test, clarithromycin resistance testing) when medical necessity criteria are met, and must deny or reject claims for experimental tests like serology, AmHPR panel, and IL-1B gene polymorphism testing.
Action Required
By March 20, 2026: Billing team must update system edits to enforce H. pylori testing coverage rules in the billing software. COVERED codes (78267, 78268, 83013, 83014, 87338, 87513) require that claims include one of the specified medical necessity ICD-10 codes. NOT COVERED codes (0008U, 83009, 83519, 86318, 86677, 87632) must be flagged for automatic denial with notification to providers that these tests are experimental/investigational under Aetna plans. Providers should be notified via bulletin that simultaneous urea breath testing AND stool antigen testing on the same patient will not be paid (only one method per episode). Update encounter templates to require documented medical necessity criteria selection before ordering. Failure to implement will result in denied claims or incorrect reimbursements.