CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Agents for Recurrent Clostridioides Difficile
Blue Cross & Blue Shield of Mississippi·MS · Gastroenterology, Infectious Disease, Internal Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
The State and School Employees' Health Insurance Plan has determined that Rebyota (fecal microbiota, live-jslm) for preventing recurrent C. difficile infection is not medically necessary. Claims for Rebyota and its administration will be denied as other covered treatment options are available.
Action Required
Immediately: Billing team must update system to flag HCPCS code J1440 (Rebyota) as not covered for State and School Employees' Health Insurance Plan members. Stop billing J1440 for these patients and verify alternative covered treatments are used. Claims for J1440 and related administration services will be denied.