Endoscopy by Capsule

Capsule endoscopy of the esophagus is covered as an alternative to conventional endoscopy to triage cirrhotic patients with portal hypertension (no prior variceal bleeding) for medium-to-large varices when they are expected to tolerate beta-blockers; variceal size must be estimated using a validated algorithm. Small-bowel capsule endoscopy is covered for occult GI bleeding, suspected small-bowel neoplasm (symptomatic or polyposis), diagnosis of suspected Crohn's disease (negative colonoscopy, no stricture), evaluation of malabsorption/chronic diarrhea/protein-losing enteropathy after prior negative testing, and preoperative mapping for AVMs/lymphangiectasia. Coverage excludes GERD evaluation, patency capsule testing, patients with suspected/known obstruction/stricture/fistula, screening for colorectal cancer, use of non-FDA-approved devices, confirmation of lesions within reach of standard endoscopy, and use for management of established Crohn's disease; required documentation of prior negative endoscopies, tolerance to beta-blockers (esophageal), and provider training/supervision is required.