TMPPM 2008 > Texas Medicaid Services > Independent Laboratory > Benefits and Limitations

26.4.6 Helicobacter Pylori (H. Pylori)

Procedure codes 5-83009, 5-83013, 5-83014, 5-86677, 5-87338, and 5-87339 are benefits of the Texas Medicaid Program.

These codes are considered to be clinical lab services and must be billed using type of service (TOS) 5. The interpretation/professional component TOS I is not separately reimbursed.

The following procedure codes are not payable on the same date of service by the same provider: 5-86677, 5-83009, 5-87338, and 5-83013 or 5-83014. Procedure codes 5-83013 and 5-83014 may be considered for reimbursement on the same day.

Procedure codes 5-83009 and 5-86677 are benefits of the Texas Medicaid Program with the following diagnosis codes:

Procedure codes 5-83013, 5-83014, and 5-87338 are benefits of the Texas Medicaid Program with the diagnoses listed above and also for diagnosis code 04186.

Refer to: "Helicobacter Pylori (H. Pylori)" for more information.