Fecal analysis has been proposed for individuals with various gastrointestinal symptoms (e.g., gas, bloating, abdominal pain) as a method to differentiate intestinal microflora and related immunologic responses that may be related to those symptoms. Fecal analysis purportedly evaluates stool for beneficial bacteria as well as imbalanced gut flora and possible pathogens.
Examples of available tests include the Comprehensive Digestive Stool Analysis (CDSA)™ ( Genova Diagnostics), and SmartGut™ (uBiome, San Francisco, CA). SmartGut™ is marketed as the first sequencing-based clinical microbiome screening test capable of detecting microorganisms that can only be detected by DNA sequencing.
Fecal analysis in the evaluation and diagnosis of intestinal disorders including, but not limited to testing the following components, is considered investigational:
Molecular-based panel testing for general screening of microorganisms (e.g., SmartGut™)
Iso-butyrate, iso-valerate, and n-valerate
Meat and vegetable fibers
Long-chain fatty acids
Total fecal fat
Total short-chain fatty acids
Levels of Lactobacilli, bifidobacteria, and Escherichia coli and other “potential pathogens” including Aeromonas, Bacillus cereus, Campylobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Salmonella, Shigella, Staphylococcus aureus, and Vibrio
Identification and quantitation of fecal yeast (including candida albicans, candida tropicalis, Rhodotorula, and Geotrichum)
Short-chain fatty acid distribution (adequate amount and proportions of the different short-chain fatty acids reflect the basic status of intestinal metabolism)
Fecal secretory immunoglobulin A (IgA)
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
No studies were identified addressing the diagnostic accuracy of fecal analysis verses other standard diagnostic approaches or that compared health outcomes in individuals managed with and without fecal analysis tests.
BlueCross BlueShield Association. Evidence Positioning System. (1:2019). Fecal analysis in the diagnosis of intestinal dysbiosis (2.04.26). Retrieved February 1, 2019 from https://www.evidencepositioningsystem.com/.(7 articles and/or guidelines reviewed)
Emmanuel, A., Landis, D., Peucker, M., & Hungin, A. (2016). Faecal biomarker patterns in patients with symptoms of irritable bowel syndrome. Frontline Gastroenterology, 7 (4), 275-282. (Level 4 evidence)
Goepp, J., Fowler, E., McBride, T., & Landis, D. (2014). Frequency of abnormal fecal biomarkers in irritable bowel syndrome. Global Advances in Health and Medicine, 3 (3), 9-15. (Level 4 evidence)
ORIGINAL EFFECTIVE DATE: 5/31/2019
MOST RECENT REVIEW DATE: 5/31/2019
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.