Harvard Pilgrim is updating our Fecal Microbiota Transplantation Medical Policy to clarify coverage criteria and add an additional CPT code as eligible for coverage. Harvard Pilgrim considers fecal microbiota transplantation medically necessary when healthy donor stool is available for transplant, and all of the following are met:
- Documentation confirms Clostridium difficile infection by a positive stool test
- At least three or more episodes of recurrent Clostridium difficile infections
- Documentation confirms episodes are refractory to at least two full courses of antibiotic regimens (e.g. metronidazole, fidaxomicin, vancomycin)
In addition, effective for dates of service beginning June 1, 2017, we are adding the following CPT code to the policy as eligible for coverage:
- 44705 – Preparation of fecal microbiota for instillation, including assessment of donor specimen
Prior authorization is not required. Please refer to the updated Fecal Microbiota Transplantation Medical Policy for complete coverage criteria.