Wednesday, June 15, 2016

Colonscopy covereage guidelines

Coverage
Coverage guidelines for colonoscopies are dependent upon the type of service being rendered.

Diagnostic and Surgical Endoscopy

A diagnostic endoscopy is a covered service if it is proven to be medically reasonable and necessary to the overall diagnosis and treatment of the patient’s condition. Services are considered medically necessary when they meet one or more of the following requirements:

• Are proper and needed for the diagnosis or treatment of the patient’s medical condition
• Are furnished for the diagnosis, direct care, and treatment of the patient’s medical condition
• Meet the standards of good medical practice
• Are not mainly for the convenience of the patient, provider, or supplier

Screening Colonoscopy

Medicare provides coverage of a screening colonoscopy for all beneficiaries regardless to age. A doctor of medicine or osteopathy must perform this screening.

• Beneficiaries at high risk for developing colorectal cancer: Medicare provides coverage of a screening colonoscopy once every two years for beneficiaries at
high risk for colorectal cancer.

• Beneficiaries not at high risk for developing colorectal cancer: Medicare provides coverage of a screening colonoscopy once every 10 years but not
within 47 months of a previous screening sigmoidoscopy.

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