Reduced Co-Insurance For Screening Colonoscopies

1
Reduced Co-Insurance For Screening
Colonoscopies
2
Reduced Co-Insurance For Screening Colonoscopies

• As per the update dated 29th April 2022, CMS
  reduced the coinsurance for certain screening
  flexible sigmoidoscopies and screening
  colonoscopies. This special coinsurance applies
  regardless of the code you bill for the
  establishment of a diagnosis as a result of the
  test, or for the removal of tissue or other
  matter or other procedure. Its effective when
  provided in connection with, as a result of, and
  in the same clinical encounter as the colorectal
  cancer screening test. The reduced coinsurance is
  being phased-in beginning January 1, 2022.
  Currently, the addition of any procedure beyond a
  planned colorectal cancer screening test (for
  which theres no coinsurance) results in the
  patient having to pay coinsurance. CMS is
  planning to gradually reduce this coinsurance
  until its completely free for dates of service
  on or after January 1, 2030.
• Effective January 1, 2022, when a screening
  colorectal cancer procedure, G0104, G0105, or
  G0121 has the PT modifier submitted on the claim
  line item with HCPCS codes 10000 69999, G0500,
  00811, or CPT code 99153 for diagnostic
  colonoscopy, or diagnostic flexible
  sigmoidoscopy, or other procedure to indicate
  that a screening colorectal cancer procedure
  HCPCS G0104, G0105, or G0121, has become a
  diagnostic or therapeutic service, coinsurance is
  reduced or waived for claims as follows
• For dates of service in calendar years 2023-2026,
  the reduced coinsurance is 15
• For dates of service calendar years 2027-2029,
  the reduced coinsurance is 10
• For dates of service on or after calendar year
  2030, Medicare waives the coinsurance

3
Reduced Co-Insurance For Screening Colonoscopies

• Background for Reduced Co-Insurance
• Section 4104 of the Affordable Care Act (ACA)
  defined the term preventive services to include
  colorectal cancer screening tests and, as a
  result, it waives any coinsurance that would
  otherwise apply under Section 1833(a)(1) of the
  Social Security Act for screening colonoscopies.
  In addition, the ACA amended Section 1833(b)(1)
  of the Act to waive the Part B deductible for
  screening colonoscopies, which includes moderate
  sedation services as an inherent part of the
  screening colonoscopy procedural service. These
  provisions are effective for services furnished
  on or after January 1, 2011.
• In the CY 2017 PFS Final Rule, the Centers for
  Medicare Medicaid Services (CMS) modified
  coding and reporting of procedural services that
  include moderate sedation as an inherent part of
  the service, including for screening
  colonoscopies. CR 10075 operationalizes the
  existing waiver of deductible and coinsurance for
  moderate sedation services furnished in
  conjunction with and in support of colorectal
  cancer screening tests. Effective January 1,
  2017, beneficiary coinsurance and deductible
  continues to not apply to the following moderate
  sedation claim lines when furnished in
  conjunction with screening colonoscopy services
  and when billed with Modifier 33 or Modifier PT
• HCPCS code G0500 Moderate sedation services
  provided by the same physician or other qualified
  health care professional performing a
  gastrointestinal endoscopic service that sedation
  supports, requiring the presence of an
  independent, trained observer to assist in the
  monitoring of the patients level of
  consciousness and physiological status patient
  age 5 years or older (additional time may be
  reported with 99153, as appropriate).

4
Reduced Co-Insurance For Screening Colonoscopies

• CPT code 99153 Moderate sedation services
  provided by the same physician or other qualified
  healthcare professional performing the diagnostic
  or therapeutic service that the sedation
  supports, requiring the presence of an
  independent, trained observer to assist in the
  monitoring of the patients level of
  consciousness and physiological status each
  additional 15 minutes of intra-service time (List
  separately in addition to code for primary
  service)
• Medisys Data Solutions is a leading medical
  billing company providing complete assistance in
  medical billing and coding. To know more about
  our billing and coding services, contact us at
  info_at_medisysdata.com/ 302-261- 9187.

5
(No Transcript)