Colon Capsule Endoscopy (CCE)

Colon capsule endoscopy (CCE) is covered when used diagnostically or for surveillance of colon polyps either as a secondary procedure after incomplete optical colonoscopy with adequate preparation or as a primary procedure in patients judged high-risk for OC/moderate sedation, provided the indication is polyp detection/surveillance or diagnostic evaluation for positive FOBT, positive sDNA, or other evidence of lower GI bleeding in hemodynamically stable patients. CCE is contraindicated in patients with GI obstruction/stricture/fistula, swallowing disorders, incompatible implanted electro-medical devices, allergies to preparation agents, and may not be used for routine colorectal cancer screening or in conjunction with CT colonography; relevant documentation (incomplete OC report, positive test results, specialist risk evaluation, and contraindication checks) must be in the medical record.

"CCE is medically necessary as a secondary procedure after an incomplete diagnostic optical colonoscopy with adequate bowel preparation when a complete evaluation of the colon was not technically po..."