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CMSNational Coverage Determination (NCD)

CMS Diagnostic Breath Analyses Form


Diagnostic Breath Analyses

Indications

(58712) Is the Diagnostic Breath Analysis test being performed to detect lactose malabsorption? 

Contraindications

(58713) Is the breath analysis performed using lactulose to diagnose small bowel bacterial overgrowth or measuring small bowel transit time? 
(58714) Is CO2 being used in the test to diagnose bile acid malabsorption? 
(58715) Is CO2 being used in the test to diagnose fat malabsorption? 
Effective Date

06/12/1984

Last Reviewed

NA

Original Document

  Reference



Background for this Policy

Diagnostic breath analyses are tests performed to measure either the hydrogen or carbon dioxide content of the breath after the ingestion of certain compounds. The analyses are performed to diagnose certain gastrointestinal disease states.

The Following Breath Test is Covered:

  • Lactose breath hydrogen to detect lactose malabsorption.

The Following Breath Tests are Excluded from Coverage:

  • Lactulose breath hydrogen for diagnosing small bowel bacterial overgrowth and measuring small bowel transit time.
  • CO2 for diagnosing bile acid malabsorption.
  • CO2 for diagnosing fat malabsorption.