45387
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Pre-operative "marking" for localization of a lesion. (3)
- Screening Colonoscopy in Average RiskPopulations(that is, asymptomatic individuals without specific risk factors including no personal history of adenomas, sessile serrated polyps [SSPs], colorectal cancer, inflammatory bowel disease, or cystic fibrosis, and no family history of colorectal cancer).Colonoscopy to detect colorectal cancer and adenomatous polyps is appropriate:Beginning at age 45 years; (13, 22, 24, 29, 38, 40, 45)andEvery 10 years thereafter. [...]
- Colonoscopy to detect colorectal cancer and adenomatous polyps is appropriate:Beginning at age 45 years; (13, 22, 24, 29, 38, 40, 45)andEvery 10 years thereafter. (11, 22, 24, 38, 40, 45)or
- Beginning at age 45 years; (13, 22, 24, 29, 38, 40, 45)and
- Every 10 years thereafter. (11, 22, 24, 38, 40, 45)or
- For individuals with a personal history of a hyperplastic, non-sessile serrated polyp (non-SSP) removed at colonoscopy, measuring less than 1 cm and in the rectum and sigmoid only, the first follow up colonoscopy is appropriate in 10 years; (15, 18, 21)or
1 Active Policy
ANTHEM-CG-SURG-01 — CG-SURG-01 Colonoscopy
Related Codes
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