Aetna Wireless Capsule Endoscopy prior authorization requirements (2026)
What Aetna generally requires to approve Wireless Capsule Endoscopy (CPT 91110, 91111, 91112, 91113), for Commercial plans. Yes. Aetna generally requires prior authorization for Wireless Capsule Endoscopy (CPT 91110, 91111, 91112, 91113).
Medical-necessity criteria Aetna generally applies
Aetna applies medical-necessity review (CPB 0588). Wireless capsule endoscopy (esophagus through ileum, CPT 91110) is medically necessary for suspected small-intestinal bleeding in patients with objective evidence of recurrent/obscure GI bleeding (e.g., persistent or recurrent iron-deficiency anemia, recurrent positive fecal occult blood test, or visible bleeding) who have had upper AND lower GI endoscopy (EGD and colonoscopy) within the past 12 months that failed to identify a bleeding source; or for initial diagnosis of suspected Crohn's disease (abdominal pain or diarrhea plus a sign of inflammation or bleeding) without evidence of disease on conventional tests.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Wireless Capsule Endoscopy. Confirm the covered diagnosis list against the current Aetna policy.
Related procedure codes
Codes often billed alongside Wireless Capsule Endoscopy: 91110, 91111, 91113. Verify the correct codes for your documentation.
Commonly required documentation
- Documentation of prior non-diagnostic EGD and colonoscopy within 12 months
- objective evidence of obscure bleeding (anemia, FOBT, visible bleeding) or suspected Crohn's with inflammatory signs.
Situations to verify before submitting
Aetna may not cover Wireless Capsule Endoscopy in these situations. Verify against the current policy rather than assuming a denial:
- As a screening test (other than esophageal varices)
- As an initial test in diagnosing GI bleeding
- In patients with known or suspected GI obstruction, strictures, or fistulas
- For colorectal cancer screening
- Evaluating the colon for indications other than incomplete colonoscopy
How to submit
- Method: Aetna precertification (Availity)
- Portal: Availity
Source
Source: Aetna CPB 0588 Capsule Endoscopy. Codes 91110, 91111, 91113. Last verified 2026-06-17.
Frequently asked questions
Does Aetna require prior authorization for Wireless Capsule Endoscopy?
Yes. Aetna generally requires prior authorization for Wireless Capsule Endoscopy (CPT 91110, 91111, 91112, 91113).
What does Aetna require to approve Wireless Capsule Endoscopy?
Aetna applies medical-necessity review (CPB 0588). Wireless capsule endoscopy (esophagus through ileum, CPT 91110) is medically necessary for suspected small-intestinal bleeding in patients with objective evidence of recurrent/obscure GI bleeding (e.g., persistent or recurrent iron-deficiency anemia, recurrent positive fecal occult blood test, or visible bleeding) who have had upper AND lower GI e… Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Turnaround varies by plan and submission method. Check the Aetna portal for current timeframes.
Submitting Wireless Capsule Endoscopy to Aetna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.