Medicare AdvantageCoverageMedium impact
Fecal Calprotectin Testing
Blue Cross Blue Shield of Rhode Island·RI · Gastroenterology, Internal Medicine, Family Medicine·Physician / Facility
Effective date
Jul 1, 2022
We identified it
Jun 19, 2026
Summary
Effective July 1, 2022, fecal calprotectin testing is no longer covered for Medicare Advantage plans and is not considered medically necessary for commercial products when used to manage confirmed inflammatory bowel disease. This represents a significant coverage restriction for gastroenterology practices.
Action Required
By July 1, 2022: Billing team must update system to deny fecal calprotectin testing claims for Medicare Advantage plans and flag commercial claims when used for managing confirmed IBD as not medically necessary. Update encounter forms to alert providers that this testing is no longer covered for these scenarios. Claims submitted will be denied without proper coverage verification.