Definition of Medical Necessity

All claims submitted to Governmental Programs for Aerodiagnostics,LLC breath testing must be medically necessary. "Medically Necessary is defined as a test or procedure that is reasonable and necessary for diagnosis and treatment of illness." Tests performed for screening purposes will not be reimbursed by Medicare. Clinicians may deem it medically necessary to order a breath test.

Requisition Forms

Clinicians can use our requisition form to order our breath tests for their patients. All breath collection kits can be shipped directly to your patients with the exception of Small Intestinal Bacterial Overgrowth (SIBO) containing Lactulose. SIBO with Lactulose can be delivered to the street address on the license of a licensed prescriber. A "one-time" Rx form must be completed and approved by the manufacturer in advance of any kits shipped to a prescriber for distribution to a patient. Alternative options for SIBO breath collection kits include ordering a SIBO with Glucose or a SIBO with Lactulose instructions but contains no Lactulose. A SIBO with Lactulose instructions can be shipped directly to patients and the prescriber can provide a prescription to the patient for Lactulose 10g in 15mL solution that can be picked up at the patient's local pharmacy. Aerodiagnostics,LLC test requisitions can be customized to simplify and streamline the ordering process. There is no need to stock breath collection kits in your office. Aerodiagnostics,LLC delivers breath collection kits directly to your patient to eliminate your staff time associated with the breath collection instruction and questions from your patients regarding the breath specimen preparation and collection.

Most importantly, by delivering breath collection kits directly to your patients Aerodiagnostics,LLC is able to reduce variability in the hydrogen and methane breath test, ultimately delivering a highly accurate result.

Clinicians and/or their staff can fill in the patient section of the Aerodiagnostics,LLC test requisition, or simply attach a patient face sheet/demographic sheet. The completed requisition can be emailed to or faxed to 1.617.860.6617. Aerodiagnostics,LLC will confirm each order via email and ship a breath collection kit directly to your patient via FedEx 2 Day delivery.

Aerodiagnostics,LLC tracks each shipment and contacts your patient to offer assistance with preparation, collection of breath specimens, return shipping, and payment questions. Aerodiagnostics,LLC processes patient specimens within 24 business hours and delivers an encrypted email link to our portal for access to your patient's final report. Aerodiagnostics,LLC personnel are available to review results and answer any questions with clinicians.

Requisition Form

Please use this form if you are a provider in the US.
It is a writeable PDF, so you can edit it directly on your computer and then email it to

Aerodiagnostics,LLC Sample Report

Sample Report

Instructions on Collecting Your Breath Specimens

SIBO - Lactulose

SIBO - Glucose

Lactose Intolerance

Sucrose Intolerance

Fructose Intolerance