Wireless Capsule Endoscopy

Wireless capsule endoscopy is covered for specific small-bowel and esophageal indications: recurrent obscure small intestinal bleeding after prior EGD and colonoscopy within 12 months, evaluation of small-bowel carcinoid tumors, selected celiac disease and Crohn's disease indications (initial diagnosis or re-evaluation when symptomatic and conventional testing is non-diagnostic), surveillance in certain hereditary polyposis syndromes, and screening/surveillance of esophageal varices. Coverage is limited by multiple exclusions (not for routine screening except esophageal varices, not for colon or stomach evaluation, not for intussusception, not for confirming other diagnostic findings), contraindications (known/suspected obstruction, strictures, fistulae, pacemakers/implanted electromedical devices, pregnancy), requirement for FDA‑approved devices, performance by endoscopy‑trained physicians or properly supervised IDTFs, and documentation of prior testing and medical necessity for repeats.