Colonoscopy Guidelines

Colonoscopy is covered for average‑risk screening (every 10 years from age 50, age 45 for African Americans, through age 85), high‑risk family screening, surveillance after polypectomy/colorectal cancer resection, and IBD/dysplasia and therapeutic indications per detailed interval tables; it is generally excluded for initial evaluation of chronic constipation without alarm features, initial acute diarrhea in immunocompetent patients, isolated abdominal pain without alarm features, and when the procedure will not change management. Approval requires specific documentation (relevant labs/stool studies for IBS/diarrhea, detailed polyp pathology: number/size/histology, BBPS bowel‑prep scores or documentation of inadequate prep, radiology descriptions, operative dates for post‑op surveillance, etc.), and certain scenarios lacking clear guidance or adequate documentation must be sent for Medical Director review.

"Colonoscopy every 10 years, beginning at age 50 (age 45 in African-Americans), up to age 85."