Defecography (CPB 0718, reviewed 2025-10-14)
Summary
Defecography is medically necessary for members with documented chronic constipation when anorectal manometry and rectal balloon expulsion results are negative or inconclusive, and when anterior rectocele, enterocele, inappropriate contraction of the puborectalis muscle, or pelvic organ prolapse is suspected. MR defecography is medically necessary for evaluation or surgical planning of obstructed defecation syndrome and other functional defecation disorders when conventional tests, including conventional defecography, have been inconclusive. Defecography for routine evaluation of constipation and for pre-operative prediction of low anterior resection syndrome is considered experimental, investigational, or unproven, and MR defecography is considered experimental, investigational, or unproven for rectal prolapse, rectal intussusception, other pelvic floor disorders, and other indications.
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