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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2018

Coverage of Fecal Calprotectin Testing

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.

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Prior Authorization No Longer Required for Cologuard Test

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Early Intervention Provider Fee Schedule Update

2018 Home Care Seasonal Flu Vaccine Fee Schedule

Documenting Deep Vein Thrombus and Pulmonary Embolism


Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator