Colon Capsule Endoscopy (CCE)

Colon capsule endoscopy (CCE) is covered when used for diagnostic or surveillance purposes in patients who are high risk for optical colonoscopy/moderate sedation (per qualified evaluator) and have a positive FOBT, positive sDNA, 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 incomplete workup for positive FOBT, sDNA, or other lower GI bleeding). CCE is not covered for patients with GI obstruction/stricture/fistula, implanted electro-medical devices (eg, pacemaker), swallowing disorders, allergies to prep agents, when performed with CT colonography, or for colorectal cancer screening under Medicare (see NCD 210.3).

"CCE is medically necessary as a primary diagnostic or surveillance procedure for patients judged to have major risks for optical colonoscopy or for moderate sedation by a board-certified/board-elig..."