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Fecal Microbiota Transplantation
Blue Cross & Blue Shield of Mississippi·MS · Gastroenterology, Infectious Disease, Internal Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
New medical policy establishes coverage criteria for fecal microbiota transplantation (FMT). FMT is considered medically necessary only for recurrent Clostridioides difficile infection with at least 2 recurrences refractory to standard antibiotic treatment. All other uses are considered investigational and not covered.
Action Required
Immediately: Billing team must verify prior authorization requirements for FMT procedures and ensure documentation shows at least 2 recurrences of C. difficile infection refractory to standard antibiotic treatment before billing. Claims for other FMT indications (IBD, IBS, constipation, etc.) will likely be denied as investigational.