Surgical Site of Care - Colonoscopy and Sigmoidoscopy
Effective November 1, 2026, the Surgical Site of Care policy for colonoscopy and sigmoidoscopy codes applies site of care medical necessity review only when the procedure is performed in an outpatient hospital setting. Use of a hospital outpatient department instead of an ambulatory surgery center or physician office may be considered medically necessary when one or more listed criteria are met, such as no geographically accessible in-network ASC that has the necessary equipment, a procedure that requires discontinuing medications that necessitate inpatient monitoring, ASA Physical Status III or higher, or a BMI over 40. When none of the criteria are met, hospital outpatient use is considered not medically necessary.