Hydrogen or Methane Breath Testing

This policy addresses hydrogen and methane breath testing as a diagnostic tool for conditions such as small intestinal bacterial overgrowth (SIBO), lactose or other sugar malabsorption/intolerance, assessment of small bowel transit/gastroparesis, and related abdominal symptoms (e.g., bloating, gas, altered bowel function). However, the policy considers these tests experimental/investigational and not covered for many indications (including SIBO, lactose intolerance, IBS), cites inconsistent methodology and limited sensitivity/specificity versus jejunal aspirate, requires use of FDA‑cleared Class I (510(k), product code NRH) devices, and is inactive for current claims adjudication.

"Diagnosis and management of small intestinal bacterial overgrowth (SIBO)."

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