Colon Capsule Endoscopy (CCE)
L38824
Colon Capsule Endoscopy (CCE) is covered by Medicare for diagnostic or surveillance use when used as a primary procedure in patients at high risk for optical colonoscopy or moderate sedation and who have qualifying positive tests (FOBT, stool DNA, or blood-based CRC biomarker) or other evidence of lower GI bleeding, and when performed as a secondary procedure after an incomplete diagnostic OC for polyp detection or related indications. CCE is contraindicated for patients with GI obstruction/stricture/fistula, swallowing disorders, interfering implanted electro-medical devices, or allergies to preparation agents, may not be performed with CT colonography, and is explicitly not covered for colorectal cancer screening (see NCD 210.3). Claims require documentation of the evaluating endoscopist's assessment, qualifying test results or incomplete OC justification, absence of contraindications, and compliance with CMS medical necessity rules.
"CCE is medically necessary as a primary procedure for diagnostic or surveillance purposes when the patient has major risks for Optical Colonoscopy (OC) or moderate sedation as determined by evaluat..."