CommercialCoverageMedium impact
Plugs for Fistula Repair 7.01.86
Excellus BlueCross BlueShield·Gastroenterology, General Surgery·Digestive System (Gastroenterology)
Effective date
Feb 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has classified all biosynthetic fistula plugs (including porcine and synthetic materials) as investigational for anal and rectal fistula repair, meaning they are not covered benefits. This policy is effective February 19, 2026.
Action Required
Before February 19, 2026: Billing team must update system to flag fistula plug procedures as non-covered for Excellus BlueCross BlueShield patients. Providers should be notified that biosynthetic fistula plugs (porcine SIS and synthetic materials) for anal/rectal fistula repair are considered investigational and will not be covered. Update prior authorization systems to automatically deny these requests and inform patients of coverage limitations before procedures.