Fecal Analysis in the Diagnosis of Intestinal Dysbiosis

This policy covers laboratory analysis of fecal samples (including fecal dysbiosis testing and hydrogen breath testing) to evaluate intestinal dysbiosis and other GI conditions such as IBS, suspected SIBO, inflammatory/autoimmune disorders, malnutrition, certain cancers, neuropsychiatric conditions, and allergy-related presentations. Coverage requires tests with demonstrated clinical validity and utility performed in CLIA-certified high‑complexity laboratories and is subject to the member’s benefit plan; many specific fecal markers, organism quantitation, and broad fecal dysbiosis panels (and their use for IBS, SIBO, or malabsorption) are considered experimental, investigational, or unproven, with jejunal aspirate culture remaining the diagnostic standard for SIBO and hydrogen breath testing acceptable only when aspirate is not feasible.

"Laboratory analysis of fecal samples to evaluate for intestinal dysbiosis"