UnitedHealthcare Wireless Capsule Endoscopy prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve Wireless Capsule Endoscopy (CPT 91110, 91111, 91112, 91113), for Medicare Advantage (policy MMP036.14; defers to applicable Medicare LCDs by MAC) plans. Yes. UnitedHealthcare generally requires prior authorization for Wireless Capsule Endoscopy (CPT 91110, 91111, 91112, 91113).
Medical-necessity criteria UnitedHealthcare generally applies
Small-bowel capsule endoscopy is reasonable and necessary for either (1) initial diagnosis of suspected Crohn's disease when conventional tests (small-bowel follow-through and upper/lower endoscopy) provide no evidence; or (2) documented continuous blood loss and anemia from obscure small-bowel bleeding where the site could not be identified by colonoscopy or endoscopy, radiographic small-bowel exams failed to reveal a source, or intraoperative enteroscopy is being considered. Esophageal capsule endoscopy is covered only for portal hypertension requiring esophageal-varices evaluation when conventional endoscopy is contraindicated.
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 UnitedHealthcare policy.
Related procedure codes
Codes often billed alongside Wireless Capsule Endoscopy: 91110, 91111, 91112. Verify the correct codes for your documentation.
Commonly required documentation
- Documentation of non-diagnostic conventional workup (SBFT, EGD, colonoscopy)
- evidence of continuous blood loss and anemia for the bleeding indication.
Situations to verify before submitting
UnitedHealthcare may not cover Wireless Capsule Endoscopy in these situations. Verify against the current policy rather than assuming a denial:
- Colorectal cancer screening
- Confirmation of lesions within reach of upper or lower endoscopes
- Known intestinal stricture or blockage (radiographically confirmed)
- Patients with cardiac pacemakers or other electromagnetic implants
- Patency capsule testing
How to submit
- Method: UnitedHealthcare provider portal
- Portal: UnitedHealthcare Provider Portal
Source
Source: UHC Medicare Advantage Medical Policy MMP036.14 Capsule Endoscopy (eff 2026-04-01). Codes 91110, 91111, 91112. Last verified 2026-06-17.
Frequently asked questions
Does UnitedHealthcare require prior authorization for Wireless Capsule Endoscopy?
Yes. UnitedHealthcare generally requires prior authorization for Wireless Capsule Endoscopy (CPT 91110, 91111, 91112, 91113).
What does UnitedHealthcare require to approve Wireless Capsule Endoscopy?
Small-bowel capsule endoscopy is reasonable and necessary for either (1) initial diagnosis of suspected Crohn's disease when conventional tests (small-bowel follow-through and upper/lower endoscopy) provide no evidence; or (2) documented continuous blood loss and anemia from obscure small-bowel bleeding where the site could not be identified by colonoscopy or endoscopy, radiographic small-bowel ex… Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
Turnaround varies by plan and submission method. Check the UnitedHealthcare portal for current timeframes.
Submitting Wireless Capsule Endoscopy to UnitedHealthcare?
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.