Plugs for Anal Fistula Repair

This policy addresses placement of anal fistula plugs (biologic or synthetic scaffolds) for repair of anal/rectal (perianal) fistulas, including fistulas related to tuberculosis, malignancy, prior radiotherapy, and inflammatory bowel disease. Coverage is constrained by limited, heterogeneous evidence with higher recurrence and complication rates reported versus advancement flaps; biosynthetic fistula plugs (including porcine small-intestine submucosa or synthetic materials) are considered experimental/unproven and not covered, and studies should represent the intended clinical population and compare the technology to appropriate alternatives with randomized trials preferred.

"Anal/rectal (perianal) fistula, including those caused by tuberculosis, cancer, prior radiotherapy, or inflammatory bowel disease"

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