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PAP517

Billing for Fecal Bacteriotherapy


Provider Administrative Policy

Section
Physician
Policy Date
January 2013
Status/Date
New/January 2013
Provider Type(s)
Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Billing for Fecal Bacteriotherapy

Fecal bacteriotherapy is a procedure which transplants stool from a healthy donor into the gastrointestinal tract of an ill individual. This is sometimes performed to treat patients with recurrent clostridium difficile infections who have failed to improve under traditional antimicrobial therapy. Stool transplant has been facilitated through a variety of techniques including enema, colonoscopy and nasogastric tube. There is currently no generally accepted consensus regarding how to perform this treatment, and charges submitted for the procedure vary significantly. We provide coverage for fecal bacteriotherapy under the following guidelines:

  • HCPCS code G0455 includes the preparation and instillation of the fecal microbiota by any method, including assessment of donor specimen. We will consider reimbursement under the use of this code.
  • We will not cover colonoscopies as a separate procedure if they are performed to administer fecal bacteriotherapy.
  • Blue Cross of Idaho reserves the right to individually evaluate the medical necessity of this therapy and all associated charges for diagnostics and other procedures requested in conjunction with this therapy.

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