Fecal Microbiota Transplantation (FMT)

This policy covers fecal microbiota transplantation (FMT) for treatment of recurrent Clostridioides difficile infection (CDI)—including CDI-associated colitis and severe complications—in patients with at least two recurrences refractory to standard antibiotic therapy (i.e., usually offered after the third CDI episode); FDA‑approved FMT products are covered for recipients aged ≥18 and select high‑risk immunocompromised individuals may be considered. Coverage is limited to conventional compounded FMT prepared under licensed provider direction in a hospital laboratory (not via stool banks) with documented informed consent, required donor/stool screening and MDRO exclusion per FDA guidance, and FMT is considered experimental/unproven for all other indications or cases not meeting guideline-defined recurrence criteria.

"Conventional compounded FMT for treatment of recurrent Clostridioides difficile infection (CDI) when there have been at least 2 recurrences refractory to standard antibiotic treatment."