CommercialCoverageMedium impact
Colonoscopy, Flexible Sigmoidoscopy and CT Colonography
Blue Cross & Blue Shield of Mississippi·MS · Gastroenterology, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
BCBS MS updated their colonoscopy, flexible sigmoidoscopy, and CT colonography policy with screening age lowered to 45 (effective 01/01/2022) and detailed medical necessity criteria for diagnostic procedures. The policy clarifies coverage guidelines for screening vs diagnostic procedures and specific circumstances when these procedures are or are not medically necessary.
Action Required
Immediately: Billing team must verify that screening colonoscopy and sigmoidoscopy claims for patients age 45+ are being processed correctly per the 01/01/2022 guidelines. Review current documentation practices to ensure medical necessity criteria are met for diagnostic procedures - unexplained bleeding, diarrhea of unknown origin, abnormal barium enema results, etc. Update encounter forms to remind providers that DRE must be performed with each screening procedure and documented.