Colon Capsule Endoscopy (CCE)

Colon capsule endoscopy (CCE) is covered for diagnostic or surveillance purposes when patients are at major risk for optical colonoscopy or moderate sedation as determined by an appropriately trained physician and have a positive FOBT, positive multitarget stool DNA test, or other evidence of lower GI bleeding in hemodynamically stable patients; CCE is also covered when diagnostic OC is incomplete for polyp detection/surveillance. Exclusions include known or suspected GI obstruction/stricture/fistula, implanted pacemakers or interfering electro-medical devices, swallowing disorders, allergies to prep medications, use with CT colonography, and CCE is not covered for colorectal cancer screening under Medicare (see NCD 210.3). Documentation must include specialist evaluation, relevant stool test results or bleeding evidence, reasons/findings for incomplete OC when applicable, and compliance with CMS medical necessity and audit requirements.

"CCE is medically necessary as a primary diagnostic or surveillance procedure when the patient is at major risk for optical colonoscopy (OC) or moderate sedation as determined by a board-certified/b..."