Fecal bacteriotherapy or fecal microbiota transplant (FMT) may be considered medically necessary as a treatment for recurrent or relapsing Clostridium difficile infection (CDI) as indicated by a positive C. difficile toxin stool test and defined as one of the following:
At least 3 episodes of mild to moderate CDI and failure of a 6-8 week taper with vancomycin with or without an alternative antibiotic (e.g., rifaximin, nitazoxanide), or
At least two episodes of severe CDI resulting in hospitalization and associated significant morbidity, or
Moderate CDI not responding to standard therapy (vancomycin) for at least a week, or
Severe fulminant C. difficile colitis with no response to standard therapy after 48 hours.