About this policy
Refer to Local Coverage Determination (LCD) L35089, Wireless Capsule Endoscopy, for reasonable and necessary requirements. The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 91110 | HCPCS | Covered |
| 91111 | HCPCS | Covered |
| A18.32 | ICD10CM | Covered |
| A18.39 | ICD10CM | Covered |
| A18.83 | ICD10CM | Covered |
| C17.0 | ICD10CM | Covered |
| C17.1 | ICD10CM | Covered |
| C17.2 | ICD10CM | Covered |
| C17.3 | ICD10CM | Covered |
| C17.8 | ICD10CM | Covered |
| C17.9 | ICD10CM | Covered |
| C49.A3 | ICD10CM | Covered |
| C49.A4 | ICD10CM | Covered |
| C78.4 | ICD10CM | Covered |
| D01.40 | ICD10CM | Covered |