Wireless Motility Capsule

This policy covers use of the wireless motility capsule (WMC) to evaluate gastrointestinal transit—including FDA‑approved assessment of suspected gastroparesis without mechanical obstruction, evaluation of GI dysmotility and slow‑transit/colonic transit (including proposed use in chronic idiopathic constipation), and as an alternative to scintigraphic gastric emptying testing. Major limitations include limited/conditional evidence of added clinical utility, exclusion in patients with suspected mechanical obstruction, strictures, altered GI anatomy or severe pyloric stenosis, and practical constraints such as ≈5‑day battery life, risk of capsule retention or data failure, and need to withhold PPIs/H2 blockers; uses beyond the listed indications are considered not medically necessary.

"Evaluation of suspected gastroparesis in patients without evidence of mechanical obstruction (FDA-approved use)."