Fecal transplantation for the treatment of Clostridium difficile infection.

ABOUT THIS POLICY: Keystone VIP Choice has developed clinical policies to assist with making coverage determinations. Keystone VIP Choice’s clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any stateor plan-specific definition of “medically necessary,” and the specific facts of the particular situation are considered by Keystone VIP Choice when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. Keystone VIP Choice’s clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. Keystone VIP Choice’s clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, Keystone VIP Choice will update its clinical policies as necessary. Keystone VIP Choice’s clinical policies are not guarantees of payment.