MedicaidCoverageLow impact
Medicaid Breast Cancer Surgery Centers
NY Medicaid·NY · Gastroenterology·Specialty Services
We identified it
May 10, 2026
Summary
New York State Medicaid has updated coverage criteria for wireless capsule endoscopy, specifying when the procedure is covered and contraindications. The policy requires trained gastroenterologists to perform the procedure using FDA-cleared devices, with documentation requirements and specific billing codes.
Action Required
For NY providers billing Medicaid: Update billing procedures to ensure wireless capsule endoscopy (CPT 91110, 91111) is only billed when performed by Medicaid-enrolled gastroenterologists using FDA-cleared devices. Ensure documentation of medical necessity is retained for 6 years and verify contraindications are ruled out. Do not bill for colon cancer screening use.