Aetna · Identified Aug 15, 2026Medium impact
Colonoscopy, Colorectal Cancer Screening, and Related Procedures (CPB 0516, reviewed 2025-11-12)
Aetna considers colorectal cancer screening medically necessary for average-risk members aged 45 years and older when their physician recommends it, with colonoscopy every 10 years, CT colonography every 5 years, annual FIT or FOBT, flexible sigmoidoscopy every 5 years, flexible sigmoidoscopy every 10 years when combined with annual FIT or FOBT, and stool DNA every 1 to 3 years. Colonoscopy or sigmoidoscopy as frequently as every 2 years is considered medically necessary for members with a first-degree relative who had CRC or adenomatous polyps, familial adenomatous polyposis, hereditary non-polyposis CRC, MYH-associated polyposis in siblings, or Cowden syndrome, and surveillance is considered medically necessary as frequently as every year for inflammatory bowel disease or a personal history of CRC. Double contrast barium enema is not considered medically necessary, and AI-aided colonoscopy, blood-based biomarkers, Guardant Shield, stool-based protein biomarkers, fecal volatile organic compound analysis, anal Pap smear, drug-coated balloons for colonic strictures, and the full-thickness resection device for appendiceal polyps are considered experimental, investigational or unproven.