Urea breath testing or fecal antigen testing may be considered medically necessary as part of the workup of patients with dyspeptic symptoms and suspected H. pylori.
Urea breath testing or fecal antigen testing may be considered medically necessary as part of the follow-up of patients with persistent symptoms after treatment for H. pylori infection.
1. Serologic testing for H. pylori may be considered medically necessary as part of the initial workup of a patient with newly diagnosed dyspepsia to guide appropriate empiric therapy.
2. The urea breath test or fecal antigen test may be considered investigational as part of the initial workup of a patient with newly diagnosed dyspepsia to guide appropriate empiric therapy; serologic testing is sufficient.
3. The urea breath test or fecal antigen test may be considered medically necessary as part of the initial workup in patients with a prior history of treated H. pylori infection and with recurrent symptoms.
4. The urea breath test or fecal antigen testing may be considered medically necessary as a follow-up test to determine H. pylori eradication in patients with peptic ulcer and either:
Persistent symptoms after an initial course of anti-H. pylori therapy; or
High-risk factors for ulcer recurrence, such as documented peptic ulcers complicated by bleeding, perforation, or obstruction.
Other indications of when the urea breath test or fecal antigen test may be considered investigational include but are not limited to:
As a routine follow-up test to determine H. pylori eradication in patients with peptic ulcer but without persistent symptoms or high-risk factors for recurrence:
As part of the initial workup of patients with dyspepsia and at increased risk for gastric malignancy; i.e., patients over the age of 50 and those with the “alarm” symptoms of anorexia, early satiety, weight loss, anemia, or gastrointestinal bleeding; these patients are candidates for immediate endoscopy.
