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

July 2016

New Medical Policy for H. Pylori Testing


Harvard Pilgrim has developed a new medical policy on testing for helicobacter pylori (H. pylori), which is a type of bacteria that causes peptic ulcers, infection of the stomach, and sometimes stomach cancer. Effective for dates of service beginning October 1, 2016, the Helicobacter Pylori Medical Policy details Harvard Pilgrim’s coverage criteria.

There are currently three types of non-invasive tests available to determine the presence of H. pylori: isotope (13C or 14C) urea breath testing, stool antigen testing, and serology antibody testing. Harvard Pilgrim considers isotope (13C or 14C) urea breath testing or stool antigen testing for the diagnosis of H. pylori in symptomatic members medically necessary. However, based on clinical evidence, Harvard Pilgrim does not consider serology antibody testing medically necessary testing for the diagnosis of H. pylori and does not reimburse for it.

For more information, please refer to the Helicobacter Pylori Medical Policy.

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