Capsule Endoscopy Guidelines

Covered: video capsule endoscopy is authorized for suspected or known small‑bowel Crohn’s disease when ileocolonoscopy and CT/MRI are negative or insufficient, refractory celiac disease after ≥6 months on a gluten‑free diet, obscure/overt GI bleeding or unexplained iron‑deficiency anemia after negative EGD and colonoscopy, suspected small‑bowel tumors, and surveillance in specified genetic syndromes; esophageal capsule is limited to patients who cannot undergo EGD, while patency capsules and colon capsule endoscopy are investigational and CE is not indicated when endoscopy with biopsy is negative for suspected celiac disease or for isolated chronic abdominal pain/diarrhea without positive inflammatory biomarkers or abnormal imaging/endoscopy. Key requirements: documentation of negative endoscopy and appropriate imaging (CT/MRI) or known disease, relevant biomarkers (ESR/CRP/fecal calprotectin) when applicable, prior CE for repeat studies, proof of contraindication to conventional endoscopy for esophageal CE, and Medical Director review for follow‑up requests and genetic‑syndrome surveillance per specified ages/timing.