Fecal Transplant

[cgmarianna]

One of the doctors in my office has started to do Fecal Transplants. Can someone please tell me how you are coding for this and if you are getting paid? This is a medicare patient. Thank you in advance.

Carol D.

 

[CodingKing]

Medicare (or any payers that use G codes)is G0455 which includes prep and installation. I assume Medicare covers it since they assigned a code to it.

*Edit* I found an LCD but only for one MAC First Coast

https://www.cms.gov/medicare-covera...Code=G0455&list_type=ncd&bc=gAAAABAAAAAAAA==&

Hmmm Google search comes up with one for CGS

http://www.cgsmedicare.com/partb/pubs/news/2015/0215/cope28449.html

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.

Commercial is 44705 for prep and 44799 for installation. I didnt look up coverage on any commercial plans