Wireless Capsule Endoscopy

Wireless capsule endoscopy is covered primarily to evaluate occult small‑bowel gastrointestinal bleeding after prior upper endoscopy and colonoscopy have failed to identify a source, and for specific indications including unexplained iron deficiency anemia, Crohn’s disease evaluation, celiac disease surveillance, indeterminate colitis, and esophageal varices in portal hypertension (esophageal capsule). Coverage is limited to FDA‑approved devices, qualified providers, and excludes use for colorectal cancer screening or to evaluate lesions reachable by conventional endoscopy; contraindications and documentation of prior endoscopies and suspected bleeding must be present.

"Wireless capsule endoscopy (WCE) is indicated to evaluate occult gastrointestinal bleeding likely from the small intestine when prior upper GI endoscopy and colonoscopy have been performed and fail..."