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Billing code

Z494A — Hereditary (e.g. Familial Adenomatous Polyposis Or Hereditary Nonpolyposis Colorectal Cancer) Or Other Bowel Disorders (e.g. Inflammatory Bowel Disease) Associated With Increased Risk Of Malignancy

High-risk condition colonoscopy

Bill for colonoscopy in a patient with a hereditary syndrome such as FAP or Lynch, or a bowel disorder like IBD raising cancer risk.

Watch for: Payable only at the age and frequency set by guidelines, and only one colonoscopy code per patient per day.

Code

Z494A

Description

Hereditary (e.g. Familial Adenomatous Polyposis Or Hereditary Nonpolyposis Colorectal Cancer) Or Other Bowel Disorders (e.g. Inflammatory Bowel Disease) Associated With Increased Risk Of Malignancy

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Colonoscopy for a patient with a hereditary syndrome (such as FAP or Lynch) or a bowel disorder like IBD that raises cancer risk.

What it covers

Z494 is a colonoscopy for diagnosis or ongoing management in a patient with a hereditary condition (for example familial adenomatous polyposis or hereditary non-polyposis colorectal cancer) or another bowel disorder (for example inflammatory bowel disease) associated with an increased risk of malignancy (S17).

Patients with serrated polyposis syndrome who need more intensive follow-up are also billed with Z494 (S16).

Billing rules

• Payable when done at the age and follow-up frequency set by generally accepted clinical practice guidelines (S17).
• Only one of Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 is payable per patient per day, and sigmoidoscopy Z580 is not payable with it the same day (S15, S17).
• The fee covers sigmoid to descending colon; add E740 (splenic flexure), E741 (hepatic flexure), E747 (cecum) or E705 (terminal ileum) for the extent reached. Fulguration is included (S18, S19).
• Add E749 when done in a private office; not payable in a hospital or ICHSC (S18, S19).
• Anaesthesia is billed as E032C (4 basic units plus time units); E003C is not payable, and GP97 time and extra units aren't payable on the colonoscopy C-suffix code (GP100, S18).
• Colonoscopy for chronic constipation is only insured for patients 50 or older, with a family history of increased cancer risk, or with alarm features (S18).
• Same-day assessment by Internal Medicine or Gastroenterology: see A120 (A104, S19). A pre-colonoscopy consultation is only payable if the chart shows it was medically necessary (GP18).

Often billed with

• E740, E741, E747 or E705 for extent beyond the descending colon (S18).
• Polypectomy Z571, Z518, Z517 or Z516 by size of the largest polyp, plus E720, E520, E519 or E518 for up to 2 more polyps per day; polyps under 3 mm aren't payable (S19).
• E749 when done in a private office (S18).
• E785 for IBD surveillance biopsies with diagnostic code 555, 556 or 576 and the required technique (S18, S19).

Related codes: Z496, Z498, Z491, Z555, E785, E747, E749, A120

Source: Schedule of Benefits (July 1, 2026), Digestive System Surgical Procedures, Intestines (Except Rectum), Colonoscopy, page S17.

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