Subject:
Colon Hydrotherapy
Description:
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IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
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Colon hydrotherapy (a.k.a. colonic irrigation, colon therapy, high colonic, enema irrigation, detoxification therapy, coffee enemas etc.) is the cleansing of the large intestine (colon) through the administration of water, herbal solutions, or other substances, such as coffee and wheatgrass extract.
Colon hydrotherapy is performed by infusing very large quantities of fluids into the colon via the rectum through a rubber or plastic tube. Warm water (often 20 gallons or more) is pumped in and out through the tube by a machine or gravity driven pump a few pints at a time, to wash out the contents of the large intestine. In contrast, regular enemas only flush out the rectum, and generally use about a quart of fluid.
The U.S. FDA classifies colonic irrigation systems as Class III devices that cannot be legally marketed except for medically indicated colon cleansing (such as before a radiologic endoscopic examination). No system has been approved by the FDA for "routine" colon cleansing to promote the general well being of a patient.
Policy:
(NOTE: For Medicare Advantage, Medicaid and FIDE-SNP, please refer to the Coverage Sections below for coverage guidance.)
There is no scientific evidence that colon hydrotherapy is effective in treating any medical condition and/or maintaining one’s health. Therefore, its benefit is unproven and its use is considered investigational.
Medicare Coverage:
Per National Coverage Determination (NCD) for Colonic Irrigation 100.7, there are no conditions for which colonic irrigation (aka colon hydrotherapy) is medically indicated and no evidence of therapeutic value. Accordingly, colonic irrigation cannot be considered reasonable and necessary within the meaning of section 1862(a)(1) of the Act and is therefore non-covered. Please refer to NCD 100.7. Available to be accessed at CMS National Coverage Determinations (NCDs) Alphabetical Index search page: https://www.cms.gov/medicare-coverage-database/indexes/ncd-alphabetical-index.aspx.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
Fide-SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
[INFORMATIONAL NOTE: The proposed rationale behind colon hydrotherapy is that "both health and disease, life and death, all begin in the colon", that "colonics" detoxify the body, and that regular "cleansing" is necessary to maintain one’s health.]
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Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
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Index:
Colon Hydrotherapy
Colon Therapy
Colonic Hydrotherapy
Colonic Irrigation
Colonic Enema
Enema Irrigation
High Colonic
Coffee Enema
Detoxification Therapy
References:
1. Centers for Medicare and Medicaid (CMS). National Coverage Determination (NCD) for Colonic Irrigation (100.7). Available at:
2. American Cancer Society. Making Treatment Decisions: Colon Therapy. Last medical review/revised: 11/01/08 (06/02/08). Available at: http://www.cancer.org/docroot/ETO/content/ETO_5_3x_Colon_Therapy.asp (last accessed 06/01/09).
3. U.S. FDA Center for Devices and Radiological Health (CDRH). Gastroenterology/Urology Devices - Therapeutic Devices: Colonic Irrigation System (Sec. 876.5220). http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?FR=876.5220 (accessed 03/18/03).
4. Baca JR. Warning letter to Tiller Mind and Body, Inc., San Antonio, Texas, June 2, 1997. FDA website. http://www.fda.gov/foi/warning_letters/m961n.pdf (accessed 03/18/03).
5. Barrett S. Gastrointestinal Quackery: Colonics, laxatives, and more. Article revised on 12/17/03. Available at Quackwatch web site at: http://www.quackwatch.org/01QuackeryRelatedTopics/gastro.html (last accessed 04/13/07).
6. Jarvis WT. Colonic Irrigation. The National Council Against Health Fraud, 1995. http://www.ncahf.org/articles/c-d/colonic.html (accessed 03/14/03).
7. Abunda Life: Colon Hydrotherapy. http://www.abundalife.com/colon.asp (accessed 03/19/03).
8. Chen TS, Chen PS. Intestinal autointoxication: a medical leitmotif. J Clin Gastroenterol 1989 Aug;11(4):434-41.
9. Ernts E. Colonic irrigation and the theory of autointoxication: a triumph of ignorance over science. J Clin Gastroenterol 1997 Jun;24(4):196-8.
10. Do you really need to 'detox' your colon? Consum Rep. 2009 Jun;74(6):13.
11. Mishori R, Otubu A, Jones AA. The dangers of colon cleansing. J Fam Pract 2011 Aug;60(8):454-7.
12. American Cancer Society. Colon Therapy. Available at: http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/manualhealingandphysicaltouch/colon-therapy (accessed 10/29/2014).
Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
* CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
The Horizon BCBSNJ Medical Policy Manual is proprietary. It is to be used only as authorized by Horizon BCBSNJ and its affiliates. The contents of this Medical Policy are not to be copied, reproduced or circulated to other parties without the express written consent of Horizon BCBSNJ. The contents of this Medical Policy may be updated or changed without notice, unless otherwise required by law and/or regulation. However, benefit determinations are made in the context of medical policies existing at the time of the decision and are not subject to later revision as the result of a change in medical policy
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