Effective for dates of service beginning Aug. 1, 2018 for our commercial members, Harvard Pilgrim will not cover fecal calprotectin testing, as it is considered experimental/investigational.
Fecal calprotectin testing is used to determine whether there are large amounts of calprotectin in the stool to indicate whether an individual has inflammatory bowel disease (IBD). However, the utility of this test for predicting IBD has not been firmly established. As a result, Harvard Pilgrim will not provide coverage for CPT code 83993 (assay for calprotectin, fecal) for commercial members.
For more information, please refer to the new Fecal Calprotectin Testing Medical Policy, and the updated Non-Covered Services Payment Policy.