Virtual Gastrointestinal Endoscopy

CT colonography (virtual colonoscopy) is covered as preventive screening every 5 years for average‑risk asymptomatic persons age ≥45 and is medically necessary for diagnostic colonic evaluation when optical colonoscopy is contraindicated due to known colonic obstruction, when colonoscopy is incomplete (e.g., diverticulosis, obstructive/stenosing lesions, redundant colon), for patients on chronic anticoagulation that cannot be interrupted, or for complications from prior optical colonoscopy. All other uses—including primary diagnosis of colorectal cancer or IBD in patients without obstruction/incomplete colonoscopy, surveillance for colorectal cancer or Lynch syndrome, MRI colonography, and virtual upper GI endoscopy—are considered experimental/investigational and not covered.

"Preventive screening: Virtual colonoscopy using computed tomography (CT colonography) performed every 5 years is medically necessary as a preventive service for colorectal cancer screening of avera..."