Medical Policy Subject: Wireless Capsule Endoscopy/ Imaging for Examination of the Gastrointestinal (gi) Tract

 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply.  If a commercial product, including an Essential Plan product, covers a specific service, medical policy criteria apply to the benefit.  If a Medicare product covers a specific service, and there is no national or local Medicare coverage decision for the service, medical policy criteria apply to the benefit.