Transanal Endoscopic Surgery (TES)

TES is medically necessary for rectal adenomas (including recurrent adenomas not amenable to other local excision), selected clinical stage T1 rectal adenocarcinomas, and selected rectal carcinoid tumors when strict anatomic, size, differentiation, and staging criteria are met. Coverage requires documentation of tumor location, size, percent circumference, biopsy/pathology and imaging demonstrating absence of lymphadenopathy or metastasis, and that the lesion is not removable by other local excision; procedures must be performed by appropriately trained providers. TES is investigational and not covered for rectal tumors that do not meet these criteria.

"Transanal endoscopic surgery (TES) is medically necessary for treatment of rectal adenomas, including recurrent adenomas not amenable to other local excision methods."

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