Capsule Endoscopy - Medicare Advantage

This policy covers capsule endoscopy procedures — including wireless capsule endoscopy (WCE) and magnetically controlled/detachable‑string MCCE (esophagus, stomach/duodenum, small bowel and colon per listed CPT codes) — for diagnostic visualization of the gastrointestinal tract. Coverage is determined by CMS Local Coverage Determinations (eg, L34081, L35089, L33774, L36427 and CCE LCDs) for patients evaluated for conditions such as obscure GI bleeding or suspected small‑bowel pathology; major limitations include that patency capsule use is not considered medically reasonable and necessary and that MCCE/patency capsule utility is limited by insufficient high‑quality evidence and LCD‑specified medical‑necessity requirements.

"Wireless capsule endoscopy (WCE) of the small bowel."

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