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Blue Cross of IdahoAll Plans · Coverage · Medical Policy · Gastroenterology, Infectious DiseaseMedium impact

2.01.92 - Fecal Microbiota Transplantation - name of bacteria was updated to Clostridioides (formerly Clostridium) difficile. Clarification on recurrent infection. Policy intent unchanged.

Effective date
Nov 20, 2025
Identified
Jun 19, 2026

Summary

Blue Cross of Idaho's fecal microbiota transplantation policy MP 2.01.92 was updated to use the current name Clostridioides difficile and to clarify recurrent infection, and the policy intent is unchanged. FMT using a conventional compounded product may be considered medically necessary for recurrent C. difficile infection after at least 2 recurrences that are refractory to standard antibiotic treatment. FMT using an FDA-approved product may be considered medically necessary under the same recurrence condition only when the recipient is 18 years of age or older, and FMT is considered investigational in all other situations. The version effective 11/20/2025 is already effective as of the analysis date of 2026-11-05.

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What to do

Action · 6 steps
01Already effective 11/20/2025: Before billing FMT for recurrent C.
02difficile infection with a conventional compounded product, confirm the patient has had at least 2 recurrences that are refractory to standard antibiotic treatment.
03Before billing FMT with an FDA-approved product, confirm the same recurrence history and that the recipient is 18 years of age or older.
04For any FMT use, confirm that the physician obtained adequate informed consent from the patient or legal representative before the intervention, that providers performed appropriate screening and testing of the stool donor and stool, and that procedures mitigating potential safety concerns of FMT were followed.
05Treat FMT in all other situations as investigational under this policy.
06Before applying this policy, identify member eligibility, the member-specific benefit plan, and related policies, because the policy may not apply to the Federal Employee Program, Medicare Supplement, Medicare Advantage, Medicaid, and certain self-insured groups.

Codes mentioned

44705G0455J1440A04.7E88.810E88.811E88.818E88.819K91.850

Original notice

2.01.92 - Fecal Microbiota Transplantation - name of bacteria was updated to Clostridioides (formerly Clostridium) difficile. Clarification on recurrent infection. Policy intent unchanged.
providers.bcidaho.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross of Idaho policiesGastroenterologyInfectious DiseaseCode 44705Code G0455Code J1440Code A04.7Code E88.810Code E88.811Code E88.818Code E88.819Code K91.850

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