Screening Colonoscopy Procedures – Site of Service – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare considers a planned preventive screening colonoscopy in a hospital outpatient department (HOPD) medically necessary only if the member meets specified high‑risk clinical criteria (e.g., MELD >8, recent MI/CVA, symptomatic arrhythmia, severe COPD/poorly controlled asthma, recent stent placement, dialysis dependence, severe OSA, uncontrolled diabetes with recurrent DKA, etc.) or if an ambulatory surgical center (ASC) is inaccessible or lacks required equipment; diagnostic colonoscopies are reviewed under the nonpreventive benefit. Medical records may be required to document the qualifying clinical criteria or inability to access an ASC, and HOPD will not be covered if these requirements are not met.

"UnitedHealthcare members may choose to receive a screening colonoscopy in an ambulatory surgical center (ASC) or other locations. We are conducting site of service medical necessity reviews, howeve..."