Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic

This policy covers diagnostic colonoscopy and sigmoidoscopy to visualize the lower gastrointestinal tract for detection of polyps, tumors, and other intestinal lesions and to allow identification of pathology and biopsy when clinically indicated. Medical records must document medical necessity, frequency, precise areas scoped, and depth reached; screening colonoscopy coverage (including follow-on colonoscopy after a positive blood-based CRC test effective 01/01/2025) is governed by separate Medicare screening policies (NCD 210.3, LCD L34614, and the IOM).

"Diagnostic colonoscopy or sigmoidoscopy is covered to directly visualize the lower gastrointestinal tract (colon, rectum, sigmoid) to detect polyps, tumors, or other intestinal lesions."

Sign up to see full coverage criteria, indications, and limitations.