Gastrointestinal Function: Selected Tests

Aetna covers colonic manometry (CPT 91117 — minimum 6 hours continuous recording including provocation tests with interpretation) to guide surgical decisions in children with refractory colonic motility/defecatory disorders, radionuclide gastric emptying studies (CPT 78264) for evaluation of GI motility disorders/gastroparesis, and MR enterography for evaluation/monitoring of Crohn’s and other small‑bowel disorders, but considers body‑surface gastric mapping (Gastric Alimetry), electrogastrography, HREPT, SmartPill wireless capsule, gastric emptying breath testing, and 3D high‑resolution manometry experimental/investigational and not covered (specific non‑covered CPT/HCPCS/ICD‑10 codes are listed). Coverage is limited to the CPB‑listed indications and documented selection criteria (e.g., gastric emptying imaging only if selection criteria are met) and only the CPT/HCPCS codes specified in the policy are payable.

"BSGM currently limited by need to establish standardized protocols and reference ranges: "BSGM reference ranges are being established to promote standardized reporting."