Colon Capsule Endoscopy (CCE)

Colon capsule endoscopy (CCE) is covered when used diagnostically or for surveillance: as a primary option for patients deemed at major risk for optical colonoscopy or moderate sedation (documented by an appropriate physician) who have a positive FOBT, positive multitarget stool DNA test, or other evidence of lower GI bleeding and are hemodynamically stable; or as a secondary procedure when a diagnostic optical colonoscopy was incomplete. CCE is not covered for patients with GI obstruction/stricture/fistula, implanted electro-medical devices that may interfere (e.g., pacemaker), swallowing disorders, allergies to prep/medications, when performed with CT colonography, or for screening indications.

"CCE is medically necessary as a primary procedure for patients judged to have major risks for optical colonoscopy (OC) or for moderate sedation by a board-certified/board-eligible gastroenterologis..."