Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · GastroenterologyMedium impact
Wireless Capsule Endoscopy for Gastrointestinal (GI) Disorders
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Wireless capsule endoscopy of the small bowel is medically necessary for suspected small bowel bleeding after prior inconclusive upper and lower GI endoscopic studies performed during the current episode of illness, for initial diagnosis of suspected Crohn disease without evidence of disease on small bowel follow-through and upper and lower endoscopy, for an established Crohn disease diagnosis when there are unexpected changes in disease course or response to treatment, and for small bowel surveillance in hereditary GI polyposis syndromes including familial adenomatous polyposis and Peutz-Jeghers syndrome. Other uses are investigational, including evaluating the extent of known Crohn disease or ulcerative colitis, the esophagus, the colon including colonic polyps or colon cancer, other GI diseases not presenting with GI bleeding, initial evaluation of acute upper GI bleeding, lower GI bleeding with major risks for colonoscopy, and patients following an incomplete colonoscopy. The patency capsule is investigational, and magnetic capsule endoscopy is investigational for unexplained upper abdominal complaints and all other indications.
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01Billing team: Bill CPT 91110 for small bowel capsule endoscopy only when the record documents one of the medically necessary indications, such as prior inconclusive upper and lower GI endoscopic studies during the current episode of illness for suspected small bowel bleeding.
02Billing team: Keep documentation in the chart that shows medical necessity, because BCBSMS makes no payment for services that are not documented to be Medically Necessary.
03Billing team: The codes listed as medically necessary are only medically necessary if the procedure is performed according to the Policy section, so check each claim against those indications.
04Billing team: Treat CPT 91111, CPT 91113 and CPT 0651T as investigational codes, and do not bill them for the investigational indications listed in the policy.
05Providers: Tell providers that a physician order or recommendation alone does not make a service Medically Necessary.
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