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Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2026-10-21)
Effective date
Not stated in the notice
Identified
Oct 29, 2026
Summary
Aetna's Clinical Policy Bulletin 0747, last reviewed 10/21/2026, covers transanal endoscopic microsurgery (TEM). Aetna considers TEM medically necessary for benign rectal tumors (adenomas), low-risk Tis and T1 rectal carcinoma, and small rectal carcinoids less than 2 cm in diameter. Aetna considers TEM experimental, investigational, or unproven for other indications, including advanced rectal cancer, anorectal melanoma, benign rectal strictures, rectal prolapse and diverticula, and megacolon. The source text does not describe what changed in this review.
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What to do
Action · 3 steps
01Billing team: Bill CPT 0184T only when the selection criteria are met, which the policy describes as benign rectal tumors (adenomas), low-risk Tis and T1 rectal carcinoma, and small rectal carcinoids less than 2 cm in diameter.
02Do not bill TEM for the experimental, investigational or unproven indications, including advanced rectal cancer, anorectal melanoma, benign rectal strictures, rectal prolapse and diverticula, and megacolon, because the policy states that its effectiveness for those indications has not been established.
03Use the ICD-10 codes the policy lists as covered only when the selection criteria are met, and do not report the ICD-10 codes the policy lists as not covered for indications in the policy.
Codes mentioned
C20D01.1D01.2D12.0D12.6D12.7D12.9D36.15B57.32C43.51C49.A0C49.A9K56.690K56.699K57.00K57.93K59.00K59.09K59.31K59.39K62.3K62.4K62.6K62.89N32.1N32.81N32.89N36.0Q42.1
Original notice
Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2026-10-21)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2025-11-26)MediumNo effective date · Medical PolicyTransrectal Ultrasound (CPB 0001, reviewed 2026-03-05)MediumNo effective date · RadiologyDefecography (CPB 0718, reviewed 2025-10-14)MediumNo effective date · Medical PolicyHigh-Resolution Anoscopy (CPB 0808, reviewed 2026-10-29)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesGeneral SurgeryGastroenterologyOncologyCode C20Code D01.1Code D01.2Code D12.0Code D12.6Code D12.7Code D12.9Code D36.15Code B57.32Code C43.51Code C49.A0Code C49.A9Code K56.690Code K56.699Code K57.00Code K57.93Code K59.00Code K59.09Code K59.31Code K59.39Code K62.3Code K62.4Code K62.6Code K62.89Code N32.1Code N32.81Code N32.89Code N36.0Code Q42.1