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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · Gastroenterology, Infectious DiseaseMedium impact

Fecal Microbiota Transplantation

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Fecal microbiota transplantation using a conventional compounded product may be considered medically necessary for the treatment of individuals with recurrent Clostridioides difficile infection who have had at least 2 recurrences that are refractory to standard antibiotic treatment. Fecal microbiota transplantation is considered investigational in all other situations. A conventional compounded product is an FMT product not involving a stool bank, where the FDA exercises enforcement discretion regarding applicable investigational new drug requirements.

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What to do

Action · 6 steps
01Requirements: The individual must have at least 2 recurrences of C.
02difficile infection that are refractory to standard antibiotic treatment before FMT is used.
03For a conventional compounded product, such as FMT prepared in a hospital laboratory under the direction of licensed health care providers, physicians must obtain adequate informed consent from the patient or legal representative before the intervention, providers must perform appropriate screening and testing of the stool donor and stool, and procedures that mitigate potential safety concerns of FMT must be followed.
04Donor screening and MDRO testing of donor stool are required as FDA protections, and stool that tests positive for MDROs must be excluded.
05Consent is obtained from the individual or a legally authorized representative in accordance with FDA guidance.
06CPT 0780T (instillation of fecal microbiota suspension via rectal enema), CPT 44705 (preparation of fecal microbiota for instillation, including assessment of donor specimen), HCPCS G0455 (preparation with instillation of fecal microbiota by any method), and ICD-10 diagnosis A04.71 (enterocolitis due to Clostridium difficile, recurrent) are medically necessary codes only when the procedure is performed according to the policy section.

Codes mentioned

44705G0455A04.71

Original notice

Fecal Microbiota Transplantation
bcbsms.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesMS policy changesGastroenterologyInfectious DiseaseCode 44705Code G0455Code A04.71

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