Colonoscopy Services – When are they Insured?

The Province of Manitoba has undertaken a number of initiatives with respect to colorectal cancer prevention such as the distribution of self-administered Fecal Occult Blood Test (FOBT) kits.  It is anticipated that the heightened awareness of colorectal cancer prevention may cause an increased demand for colonoscopy and other diagnostic services, including an increase in requests to receive colonoscopies from asymptomatic patients.

It is important to note however, that not all colonoscopy services are insured. Services provided by a medical practitioner for the purpose of diagnostic screening alone are not insured unless otherwise agreed to by the Minister.  Accordingly, a claim for a colonoscopy service with an ICD code description that states “screening” will not necessarily be paid by Manitoba Health unless certain conditions are met.

Manitoba Health has determined that colonoscopy tariffs 3185 or 3186 are payable where the service is requested for:

  1. a symptomatic patient,Note: “Symptomatic patient” includes but is not limited to a patient who has a personal history of colorectal cancer, adenomatous polyps, inflammatory bowel disease, or a positive result on a self-administered fecal occult blood test (FOBT).
  2. an asymptomatic patient with a family history of colorectal cancer; orNote: “Family history” means at least one first-degree relative (parent, sibling or child) or at least two second-degree relatives (grandparents, grandchildren, uncles, aunts, nieces, nephews or half-siblings) who have been diagnosed with colorectal cancer.
  3. an asymptomatic patient who is fifty (50) years of age or older.

Billing Note 

  • Tariffs 3185 or 3186 are payable once every thirty-six month (36) period in respect to each asymptomatic patient.
  • A colonoscopy on an asymptomatic patient under 50 years of age with no family history is not an insured service.
Questions?

Braden Kalichuk
bkalichuk@docsmb.org
(204) 985-5848

 

Updated: November 2016