Bulletin 260702 — Changes to colonoscopy and colorectal cancer screening
Changes to colonoscopy services and colorectal cancer screening reporting to align with updated ColonCancerCheck program recommendations.
To: All Physicians
Category: Physician Services, Primary Health Care Services
Written by: Physician Relations and Contract Oversight Branch
Date issued: July 17, 2026
Bulletin Number: 260702
Overview
The Ministry of Health is working with Ontario Health (Cancer Care Ontario) to align payment of colonoscopy services and colorectal cancer screening reporting to the updated recommendations for colorectal cancer screening under the ColonCancerCheck (CCC) program.
This communication outlines the changes to colonoscopy services and colorectal cancer screening reporting under the updated CCC recommendations to assist physicians in claims submissions and identifying eligible patients for cancer screening services.
ColonCancerCheck recommendations can be found here.
Changes to payment of colonoscopy services
Effective July 1, 2026, the following colonoscopy claims codes were changed to align to the updated CCC recommendations:
- Z492 – follow up of normal colonoscopy (Z499) absence of intervening signs or symptoms – sigmoid to descending
- Z493 – follow up of normal colonoscopy (Z497, Z555), absence of intervening signs or symptoms – sigmoid to descending
- Z498 – Follow up of abnormal colonoscopy – sigmoid to descending colon
- Z499 – Absence of signs or symptoms, family history associated with an increased risk of malignancy, in accordance with current Ontario generally accepted clinical practice guidelines – sigmoid to descending colon
For people at increased risk due to family history, screening with colonoscopy should be repeated every 5 years beginning at age 40, or 10 years earlier than the youngest age a relative was diagnosed (whichever comes first).
For people with colonoscopy findings requiring surveillance, review the findings of the prior colonoscopies to determine when the next colonoscopy should be. For more information on surveillance intervals, please refer to ColonCancerCheck’s Post-Polypectomy Surveillance Recommendations.
There has been no change to the program recommendations regarding the screening interval for people at average risk of colon cancer. ColonCancerCheck recommends screening people at average risk of colon cancer with Fecal Immunochemical Test (FIT) every two years. A person with an abnormal FIT result should receive a follow-up colonoscopy. Their next steps (including recommended test and interval) depends on their findings at colonoscopy. As outlined in the existing language, people should return to screening with FIT in 10 years after a negative colonoscopy, and there are some people who should return to screening with FIT earlier. More specifically, people with 1 – 2 low risk adenomas found at colonoscopy should return to screening with FIT in 5 years.
FIT testing will now be eligible for patients aged 45, in alignment with the new recommendations. The fee codes applicable to FIT testing are:
- Q150 – Colorectal Cancer Screening Fee
- Q152 – Colorectal Cancer Screening Test Completion Fee
Changes to primary care Target Population Service Reporting (TPSR)
Effective July 1, 2026, the start age for screening people at average risk of colorectal cancer has been lowered to age 45 (formerly 50). Therefore, in the TPSRs produced in September 2026, the colorectal cancer screening category target population will now report enrolled patients who are between 45 to 74 years of age, inclusive, and will continue to list any preventive care service received within the reporting period.
Claims system changes
Changes to the new recommendations take effect July 1, 2026, but some claims system updates won’t be implemented until August 2026.
To ensure appropriate payment, consider holding eligible claims with a July service date for follow up or repeat colonoscopy services that fall between the 5-year and 10-year.
If eligible claims within the 5–10-year follow-up interval are submitted and rejected to an error report or paid at $0.00 with a related explanatory code, they can be resubmitted in August 2026.
An INFOBulletin will confirm when updates are complete, and claims can be submitted/resubmitted.
Keywords/Tags
Colonoscopy; Colorectal; ColonCancerCheck; Ontario Health; Preventive Care; TPSR
Contact information
Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call