Transanal endoscopic microsurgery may be considered medically necessary for treatment of rectal adenomas, including recurrent adenomas that cannot be removed using other means of local excision.
Transanal endoscopic microsurgery may be considered medically necessary for treatment of clinical stage T1 rectal adenocarcinomas that cannot be removed using other means of local excision and that meet all of the following criteria:
Located in the middle or upper part of the rectum,
Well- or moderately differentiated (G1 or G2) by biopsy,
Without lymphadenopathy, and
Less than one-third the circumference of the rectum.
Transanal endoscopic microsurgery is considered investigational for the treatment of rectal tumors that do not meet the criteria noted above.
