Diagnostic Colonoscopy

Diagnostic colonoscopy is covered for evaluation of clinically significant imaging abnormalities, unexplained gastrointestinal bleeding, iron deficiency anemia, surveillance after polyp or cancer resection, and in inflammatory bowel disease per specified duration-based surveillance intervals. Coverage requires meeting CMS medical necessity and applicable NCDs and may be audited; diagnostic colonoscopy is not indicated for left-sided ulcerative colitis >15 years if disease is limited to the rectosigmoid colon.

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