Not all colonoscopy services are insured. A medical practitioner’s services for diagnostic screening alone are not insured unless otherwise agreed to by the Minister. As such, unless the patient meets certain conditions, Manitoba Health may not necessarily make payment on a claim for a colonoscopy service with an ICD code description that states “screening.” Manitoba Health has determined that colonoscopy Tariff 3185 or Tariff 3186 are payable where the service is requested for:
- A Symptomatic Patient
Which 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)
- An Asymptomatic Patient With A Family History Of Colorectal Cancer
In which case, “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.
- An Asymptomatic Patient Who is Fifty (50) Years of Age or Older.
- Tariff 3185 or Tariff 3186 are payable for each asymptomatic patient once every 36 months.
- A colonoscopy on an asymptomatic patient under 50 years of age with no family history is not an insured service.
April 8, 2021