Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

This LCD covers colonoscopy, sigmoidoscopy, and proctosigmoidoscopy when used diagnostically or therapeutically (not for routine colorectal cancer screening), including evaluation of imaging abnormalities, unexplained GI bleeding, positive fecal occult blood, iron deficiency anemia, surveillance for colorectal neoplasia, inflammatory bowel disease surveillance when duration criteria are met, and a range of therapeutic interventions (polypectomy, foreign body removal, decompression, palliative treatments). Coverage excludes routine screening uses addressed elsewhere and generally excludes procedures for chronic stable IBS, acute diarrhea, hemorrhoids, preoperative screening for non-colonic disease, confirmed upper GI bleeding sources, and acute severe inflammatory conditions (e.g., fulminant colitis, perforation, acute severe diverticulitis), and requires appropriate medical-necessity documentation and patient notification when coverage is uncertain.

"Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered to evaluate an abnormality on barium enema or other imaging likely to be clinically significant (e."