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Blue Cross & Blue Shield of MississippiAll Plans · Administrative · Medical Policy · General Surgery, Gastroenterology, OncologyLow impact

Transanal Endoscopic Microsurgery

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Transanal endoscopic microsurgery may be considered medically necessary for treatment of rectal adenomas, including recurrent adenomas, that cannot be removed using other means of local excision. It may also be considered medically necessary for clinical stage T1 rectal adenocarcinomas that cannot be removed using other means of local excision and that meet all listed criteria. Transanal endoscopic microsurgery is investigational for rectal tumors that do not meet those criteria. The 05/19/2026 review left the policy statements unchanged and removed ICD-9 procedure and diagnosis codes from the code reference.

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What to do

Action · 5 steps
01Billing team: For rectal adenomas, confirm the adenoma cannot be removed using other means of local excision, including recurrent adenomas.
02For rectal adenocarcinoma, confirm all criteria are met: clinical stage T1, cannot be removed using other means of local excision, located in the middle or upper part of the rectum, well or moderately differentiated (G1 or G2) by biopsy, without lymphadenopathy, and less than 1/3 circumference of the rectum.
03Clinical staging is determined from physical examination, imaging, and biopsy results.
04Rectal tumors that do not meet these criteria are investigational, and investigative services are not considered medically necessary.
05For Federal Employee Program members, FDA-approved technologies may be assessed only on the basis of medical necessity.

Codes mentioned

C20D12.7D12.8D12.9D01.1D01.2

Original notice

Transanal Endoscopic Microsurgery
bcbsms.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesGeneral SurgeryGastroenterologyOncologyCode C20Code D12.7Code D12.8Code D12.9Code D01.1Code D01.2

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