CommercialCoverageMedium impact
Capsule Endoscopy 6.01.27
Excellus BlueCross BlueShield·Gastroenterology·Digestive System (Gastroenterology)
Effective date
Oct 16, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their capsule endoscopy policy (effective October 16, 2025) defining specific medically necessary indications for CPT codes 91110 and 91111, while declaring many other capsule endoscopy uses as investigational and non-covered.
Action Required
Before October 16, 2025: Billing team must update prior authorization and coverage verification processes for capsule endoscopy codes 91110 and 91111. Verify medical necessity meets one of six approved indications (small bowel bleeding, Crohn's disease diagnosis/monitoring, celiac disease monitoring, hereditary polyposis surveillance, or esophageal varices screening in cirrhotic patients). Flag investigational codes 0651T, 91112, 91299, and 0977T as non-covered. Update encounter forms to include documentation requirements for approved indications.