Fecal Microbiota Transplantation

Fecal microbiota transplantation may be considered medically necessary for the treatment of individual 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 is considered investigational in all other situations.