Heliocobacter Pylori Infection Testing LCD - Effective May 27, 2019

The following Local Coverage Determination (LCD) has completed the Open Public and Contractor Advisory Committee (CAC) comment period and is now finalized under contractor numbers 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV) and 01911 (CA, HI & Territories). Responses to comments received may be found as a link at the bottom of the final LCD.  

Medicare Coverage Database (MCD) Number/Contractor Determination Number: L37624
LCD Title: Heliocobacter Pylori Infection Testing
Effective Date: May 27, 2019
Summary of LCD: This policy provides limited coverage for Helicobacter pylori (H. pylori) infection testing by carbon isotope (13C or 14C) urea breath testing or stool antigen testing. This policy also denies coverage for H. pylori serology, TZAM H. pylori multiplex PCR testing, plasma pepsinogen II testing, tonsillar H. pylori colonization, IL1B-31>T polymorphism testing for H. pylori, tumor necrosis factor-alpha (TNFa), and AmHPR Helicobacter antibiotic resistance next generation sequencing panel testing.

Access Noridian Future Effective LCDs.

  • Go to Future LCD webpage
    • The End User Agreement for Providers will appear if you have not recently visited the website. Select "Accept" (if necessary)
  • Select coordinating state and locate above listed CMS MCD number or LCD title
    • This link will redirect you to state specific Future Effective LCD on CMS website

Last Updated Apr 08, 2019