FMT is a non-covered service at this time as a statutorily excluded service. Any other services performed that are related to the FMT procedure will also be denied as non-covered, including but not limited to anoscopy and donor specimen.

Does insurance cover FMT?

Is it covered by my health insurance? There is no “fee” for the FMT itself. The procedure is performed during a colonoscopy or sigmoidoscopy, which is usually allowed for patients who have recurring C. diff infection with chronic diarrhea.

Who is eligible for FMT?

According to the American Gastroenterological Association, FMT may be an option for people who have had one of the following: At least three episodes of mild to moderate C. difficile infection that have not responded to six to eight weeks of treatment with antibiotics. Have had at least two episodes of severe C.