Endoscopy

Endoscopic procedures of the gastrointestinal tract are covered when they are reasonable and necessary for the individual patient, including both diagnostic uses and therapeutic procedures such as polypectomy and papillotomy for bile duct stone removal. Coverage requires documentation in the medical record that supports the medical necessity; procedures that are not reasonable and necessary are not covered.

"Endoscopic procedures are covered when determined reasonable and necessary for the individual patient."

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