Medicare AdvantageBilling CodesMedium impact
MA07.022f, Capsule Endoscopy
Independence Blue Cross·Gastroenterology, Internal Medicine, General Surgery·Medical Policy
Effective date
Oct 20, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued MA07.022f to confirm continued coverage of wireless capsule endoscopy for specific gastrointestinal indications and to add CPT code 0977T (upper gastrointestinal blood detection sensor capsule) as experimental/investigational, effective 10/20/2025. Billing teams must update systems to deny claims for 0977T and ensure only covered indications are billed under covered CPT codes 91110, 91111, and 91113.
Action Required
By 10/20/2025: Billing team must update billing system to classify CPT code 0977T (upper gastrointestinal blood detection sensor capsule) as experimental/investigational and deny all claims submitted with this code for Independence Blue Cross Medicare Advantage plans. Simultaneously, verify that covered CPT codes 91110, 91111, and 91113 are linked in the system to the specific approved diagnosis codes and indications listed in the policy (occult GI bleeding after failed upper/lower endoscopy, celiac disease surveillance, Crohn disease small bowel evaluation, indeterminate colitis, and esophageal varices with portal hypertension). Update encounter forms and billing guidelines to reflect that capsule endoscopy for blood detection remains non-covered. Train billing staff that claims for 0977T will be automatically denied and that only the three covered CPT codes are billable when medical necessity criteria are met. Failure to implement these changes will result in claim denials and potential compliance issues.