Capsule Endoscopy

Capsule endoscopy is covered for evaluating locoregional small‑bowel carcinoid in carcinoid syndrome; for celiac disease with positive serology when the patient cannot undergo EGD with biopsy or for re‑evaluation if symptomatic; and for initial or re‑evaluation of suspected Crohn’s disease when inflammatory signs are present and conventional imaging and endoscopy are non‑diagnostic or symptoms persist. It is considered experimental/investigational (not covered) as a screening test (except for esophageal varices), as an initial test for GI bleeding, for nonspecific abdominal pain unless above criteria are met, and in patients with known or suspected GI obstruction/stricture/fistulae or implanted electro‑medical devices (e.g., pacemakers).

"ICD-10 codes covered if selection criteria are met (for capsule endoscopy - esophagus through ileum): K90."

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