Insurance Information

The CPT code most generally used by a physician who performs the procedural and diagnostic portion of the test is 91065 in this case, defined as "Breath Hydrogen Test"

When a breath test kit is sent to the laboratory for analysis from a physician's office, the lab bills the patient's insurance plan for the assay portion of the test only.
When the doctor is not doing the assay, the modifier -26 is attached to the code. This denotes the professional component as separate from the technical component and can be written as 91065-26.

In order to prove medical necessity for doing the hydrogen breath test, the proper diagnostic codes must be given to the laboratory by the physician.

Here are a few codes that may be applicable

R109: Unspecified abdominal pain
R140: Abdominal distension (gaseous)
R1084: Generalized abdominal pain
R197: Diarrhea, unspecified
K580: Irritable bowel syndrome with diarrhea

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