MED.00090 Wireless Capsule for the Evaluation of Suspected Gastric and Intestinal Motility Disorders

This policy addresses the wireless motility capsule (SmartPill Motility Testing System) used to evaluate suspected gastric and intestinal motility disorders. Anthem deems this technology investigational and not medically necessary for all indications, including suspected gastroparesis and suspected intestinal motility disorders; therefore, it is not covered. There are no covered indications under this policy; related billing codes include CPT 91112 and HCPCS G1384.

"A wireless capsule (SmartPill Motility Testing System) is consideredinvestigational and not medically necessaryfor evaluation of all conditions including, but not limited to the following:"

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