Medicare AdvantageCoverageMedium impact
Capsule Endoscopy - Medicare Advantage (Revised)
Humana·Gastroenterology, Internal Medicine, General Surgery·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Jun 24, 2026
Summary
This is a new Medicare Advantage policy covering capsule endoscopy procedures effective February 2026. The policy establishes coverage criteria for esophageal, small bowel, and colon capsule endoscopy, while specifically excluding newer technologies like magnetically controlled capsule endoscopy and AI-assisted blood detection systems.
Action Required
Before February 2, 2026: Billing team must update Medicare Advantage billing protocols to ensure capsule endoscopy claims (CPT 91110, 91111, 91113) meet specific LCD criteria by jurisdiction. Update denial management procedures to exclude experimental codes 0651T and 0977T from Medicare Advantage billing. Review and implement jurisdiction-specific coverage requirements based on MAC territories.