Colonoscopy Guidelines

eviCore covers colonoscopy for screening, high‑risk/family‑history surveillance, post‑polypectomy and post‑cancer resection surveillance, IBD surveillance, bleeding/therapeutic indications, and after abnormal noninvasive stool tests, while excluding routine colonoscopy for chronic constipation or acute diarrhea without alarm features and colonoscopy for metastatic unknown primary when results will not alter management. Key requirements include a recent pertinent clinical evaluation (within ~60 days), and submission of supporting labs, imaging, prior procedure reports, and pathology (polyp size/number/histology or family‑member pathology), documentation of alarm features when applicable, and bowel‑prep adequacy or prior inadequate‑prep reports to establish medical necessity.

"For stricture dilation or percutaneous cecostomy: documentation of the nature of the stricture (e."