Fecal microbiota transplantation using a compounded product (see Policy Guidelines) may be considered medically necessary for the treatment of individuals with recurrent Clostridioides difficile infection under the following condition (see Policy Guidelines section for U.S. Food and Drug Administration Guidance):
There have been at least 2 recurrences that are refractory to standard antibiotic treatment.
Fecal microbiota transplantation using a Food and Drug Administration (FDA)-approved product may be considered medically necessary for the treatment of individuals with recurrent Clostridioides difficile infection under the following condition (see Policy Guidelines section for U.S. Food and Drug Administration Guidance):
There have been at least 2 recurrences that are refractory to standard antibiotic treatment; and
The recipient is 18 years of age or older.
Fecal microbiota transplantation is considered investigational in all other situations.
