2026 Spousal Impoverishment Income and Resource Levels Increase
AI Summary
New York State Medicaid updated coverage criteria for wireless capsule endoscopy, specifying that it's only covered when conventional endoscopy cannot identify pathology or is contraindicated, and must be performed by Medicaid-enrolled gastroenterologists using FDA-cleared devices. Colon cancer screening is explicitly excluded from coverage.
Action Required
Immediately: Update billing system to flag CPT codes 91110 and 91111 for wireless capsule endoscopy to require documentation of medical necessity showing conventional endoscopy was unable to identify pathology or is contraindicated. Ensure gastroenterologists document that FDA-cleared devices are used and retain documentation for 6 years. Do not submit claims for colon cancer screening using these codes as they will be denied.
Affected Billing Codes
Plan Types
Medicaid
States
NY
Specialties
gastroenterology