Transcription of Capsule Endoscopy – Medicare Advantage Policy Guideline
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Capsule Endoscopy – Medicare Advantage Policy Guideline
UnitedHealthcare Medicare Advantage Policy Guideline Capsule Endoscopy Guideline Number: Approval Date: March 10, 2021 Terms and Conditions Table of Contents Page Related Medicare Advantage Policy Guideline Policy Summary .. 1 Category III CPT Codes Applicable Codes .. 3. References .. 9 Related Medicare Advantage Coverage Summary Guideline History/Revision Information .. 10 Gastroesophageal and Gastrointestinal (GI) Services Purpose .. 12 and Procedures Terms and Conditions .. 13. Policy Summary See Purpose Overview Wireless Capsule Endoscopy (WCE) requires that the patient ingest a small Capsule containing a disposable light source, miniature color video camera, battery, antenna and a data transmitter. The self-contained Capsule is made of specially sealed biocompatible material that is resistant to the digestive fluids throughout the gastrointestinal (GI) tract.
undergone an upper GI endoscopy, and lower GI colonoscopy, but have failed to reveal a source of bleeding. An episode of illness is defined as the time frame from the onset of signs and symptoms until the GI bleeding is resolved.
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