Is a Colonoscopy is considered preventive or diagnostic?
This question has come up a few time recently and the answer is a bit nuanced. It depends! If it's time for your first colonoscopy (min age is 50 for eBenefits plans), it will most certainly be considered preventive with your eBenefits Summit or Essential plan which covers preventive services 100%. It gets a little more complicated if something is found, such as polyps. Once polyps are found, for example, the procedure becomes diagnostic in nature for the removal and testing of the polyps. Further, once someone has a colonoscopy where polyps are discovered all future colonoscopies are coded as "diagnostic."
As always the best course of action to determine if anything is considered preventive and will (or will not) be covered is to contact eBenefits third party administrator ARM at 800-392-1770. If your procedure is not preventive, it's best to contact Sedera if you believe the cost will exceed your IUA. Please reach out to them at
memberservices@sedera.com
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