Transanal Endoscopic Microsurgery

Transanal endoscopic microsurgery (TEM/TEMS) is covered as a minimally invasive transanal technique for local excision of rectal lesions including adenomas, large polyps not removable by colonoscope, selected benign conditions (strictures, fistulae, presacral masses, abscesses), small carcinoid tumors, and selected T1 rectal adenocarcinomas that meet all of the following: located in the middle/upper rectum, well- or moderately differentiated (G1–G2), no lymphadenopathy, and involving <1/3 of the rectal circumference. Major limitations: TEM is reserved for lesions not amenable to direct transanal or endoscopic removal and is not indicated for tumors >4 cm, T2 or higher, poorly differentiated tumors, lesions with lymphadenopathy or ≥1/3 circumference, or when lymph node sampling or formal oncologic resection is required; coverage is subject to the member’s benefit plan.

"Treatment of rectal adenomas, including recurrent adenomas that cannot be removed by other means of local excision."