Colon Capsule Endoscopy (CCE)

Colon Capsule Endoscopy (CCE) is covered when used diagnostically or for surveillance in patients who are at major risk for optical colonoscopy or moderate sedation (per evaluation by a qualified endoscopy clinician) and who have a positive FOBT, a positive multitarget stool DNA test, or other evidence of lower GI bleeding in hemodynamically stable patients. CCE is also covered as a secondary procedure when a diagnostic optical colonoscopy was incomplete, including incompleteness following positive FOBT or sDNA or other evidence of bleeding. CCE is not covered for colorectal cancer screening and is contraindicated in patients with GI obstruction/stricture/fistula, incompatible implanted electro-medical devices, swallowing disorders, allergy to preparation agents, or when performed with CT colonography.

"CCE is medically necessary as a primary procedure for patients judged to have major risks for optical colonoscopy or moderate sedation by a board certified/board eligible gastroenterologist, an end..."