Colon Capsule Endoscopy (CCE)

Colon capsule endoscopy (CCE) is covered as a secondary test after an incomplete optical colonoscopy with adequate preparation when complete evaluation was not possible, and as a primary alternative for patients at high risk for optical colonoscopy or moderate sedation, for either polyp surveillance or diagnostic evaluation following positive stool/blood tests or other evidence of lower GI bleeding in hemodynamically stable patients. CCE is excluded for patients with GI obstruction/stricture/fistula, swallowing disorders, device incompatibility (e.g., pacemaker interference), contraindications/allergies to preparation medications, when used concurrently with CT colonography, and is not covered for routine colorectal cancer screening in asymptomatic individuals. Documentation must include the incomplete OC and bowel prep status (for secondary use), positive diagnostic test results or bleeding evidence, prior polyp diagnosis for surveillance, and a qualified endoscopist's risk assessment for primary-procedure use.