Colon Capsule Endoscopy (CCE)
L38777
Colon capsule endoscopy (CCE) is covered when used diagnostically or for surveillance in patients who cannot undergo optical colonoscopy due to major procedural or sedation risks (documented by an appropriate physician) and who have positive stool/blood CRC tests or other evidence of lower GI bleeding, or when used as a secondary test after an incomplete diagnostic colonoscopy for polyp detection/surveillance. Coverage excludes patients with GI obstruction/stricture/fistula, implanted electro-medical devices that may interfere, swallowing disorders, allergies to prep agents, concurrent CT colonography, and CCE is not covered as a Medicare colorectal cancer screening test (see NCD 210.3). Documentation must include physician risk evaluation, qualifying test results, records of incomplete OC when applicable, and compliance with CMS medical necessity and audit requirements.
"CCE is covered as a primary procedure when a board-certified/board-eligible gastroenterologist, a surgeon trained in endoscopy, or equivalently trained physician documents that the patient has majo..."