Clinical Indications for Proctoscopy, Sigmoidoscopy and Colonoscopy procedures (Codes 450,453, 454, 455, 456, 457, 530, 535, 536 & 540):
(Use for initial procedure only, refer to repeat and surveillance criteria for follow-up procedures except in the instance of new and different clinical presentation to previous initial scope)
No benefit is available for repeat Proctoscopy, Sigmoidoscopy and Colonoscopy within 36 months of the initial examination except for the following clinical indications:
New clinical presentation will not be excluded by a prior colonoscopy, please refer to initial colonoscopy clinical indications and/or submit a detailed medical report with the claim
No benefit is available for a surveillance Proctoscopy, Sigmoidoscopy and Colonoscopy except for the following clinical indications: