All PlansCoverageMedium impact
Plugs for Anal Fistula Repair
Blue Cross & Blue Shield of Mississippi·General Surgery, Gastroenterology·Medical Policy
Effective date
Jan 31, 2025
We identified it
Jun 20, 2026
Summary
This policy update clarifies that biosynthetic fistula plugs (including porcine small intestine submucosa plugs) are considered investigational for anal fistula repair. The policy was recently updated but the coverage determination remains unchanged - these devices are not covered as they do not meet medical necessity standards.
Action Required
Immediately: Billing team must verify that claims for anal fistula plug procedures (CPT 46707) are not being submitted to this payer as they are considered investigational and will be denied. Review any pending claims for these procedures and advise providers that these devices are not covered. Update billing system to flag CPT 46707 as non-covered for this payer.