Colonoscopy Guidelines

Covered: colonoscopy is indicated for average-risk screening every 10 years starting at age 45 up to 85, for high-risk/familial and genetic-syndrome surveillance and post-polypectomy/CRC/IBD follow-up per the guideline’s specified intervals (e.g., 3–10 years depending on polyp type/number, 3–6 months for piecemeal resections ≥20 mm, CRC and IBD surveillance schedules), and for therapeutic/diagnostic indications; not indicated routinely for isolated abdominal pain, chronic constipation without alarm features, acute self-limited diarrhea, or metastatic cancer when results will not alter management. Key requirements: approval requires adequate recent documentation (detailed history/physical within ~60 days or equivalent), relevant labs/imaging, prior procedure and pathology reports (including BBPS for prep adequacy), family history/genetic test results when applicable, and requests lacking these details or outside recommended ages/intervals may be denied or referred for medical review.