About this policy
This article only applies to diagnostic colonoscopies and sigmoidoscopies. Sigmoidoscopy and colonoscopy testing allows for the direct visualization of the lower gastrointestinal tract. Inspection is performed with an illuminated tube. These procedures are performed to detect polyps, tumors and other lesions of the intestines. The site of pathology can be identified during a colonoscopy, and a biopsy can be obtained. Refer to associated LCD L34614. Medicare has expanded “complete colorectal cancer screening” in § 410.37(k) to include a follow-on screening colonoscopy after a positive covered blood-based biomarker noninvasive CRC screening test (described and authorized in NCD 210.3) effective 01/01/25. Refer to the Medicare Internet Only Manuals (IOM) for coverage of colorectal cancer screening procedures. Documentation Requirements The medical record should support the medical reasonableness, necessity and frequency of the diagnostic test performed. This documentation should be made available to the Contractor upon request. Documentation must indicate the precise areas scoped and the depth reached during colonoscopy. Utilization Guidelines It is expected that these services would be performed as indicated by current medical literature and/or standards of practice.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 44388 | HCPCS | Covered |
| 44389 | HCPCS | Covered |
| 44390 | HCPCS | Covered |
| 44391 | HCPCS | Covered |
| 44392 | HCPCS | Covered |
| 44394 | HCPCS | Covered |
| 44401 | HCPCS | Covered |
| 44402 | HCPCS | Covered |
| 44403 | HCPCS | Covered |
| 44404 | HCPCS | Covered |
| 44405 | HCPCS | Covered |
| 44406 | HCPCS | Covered |
| 44407 |