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Fecal Microbiota Transplantation 2.01.48
Effective date
Sep 17, 2026
Identified
Jun 20, 2026
Summary
Fecal microbiota transplantation (FMT) is considered medically appropriate for adults with recurrent Clostridioides difficile infection when the patient has had two or more recurrences after the initial episode despite standard antibiotic treatment, for a total of three or more episodes, and the appropriate donor stool screening has been completed. FMT is considered investigational for all other indications, including first-line treatment for CDI and the treatment of inflammatory bowel disease. The current effective date is September 17, 2026, and the most recent annual review kept the policy intent unchanged.
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What to do
Action · 6 steps
01Already effective September 17, 2026: Billing team, before billing FMT (CPT 44705 and 0780T, or HCPCS G0455), confirm the patient is an adult with recurrent CDI who has had two or more recurrences after the initial episode despite standard antibiotic treatment, for a total of three or more episodes.
02Confirm the appropriate donor stool screening has been completed, because FMT should be performed with appropriately screened donor stool.
03Confirm the service is not for first-line treatment of CDI or for inflammatory bowel disease, which the policy considers investigational.
04CPT 44705 covers preparation of fecal microbiota for instillation, including assessment of donor specimen.
05The policy notes that no national or regional Medicare coverage determination addresses fecal microbiota transplant.
06Codes may not be covered under all circumstances.
Codes mentioned
44705G0455A04.72
Original notice
Fecal Microbiota Transplantation 2.01.48
excellusbcbs.com · Always check the source before changing claims.