General Surgery Coding Alert
Look for Medicare Colonoscopy Coverage Change
Question: Is there a change this year in how Medicare pays for colorectal cancer screening colonoscopy that results in a biopsy or polyp removal? Texas Subscriber Answer: Medicare isn’t changing anything for 2021, but the Consolidated Appropriations Act, 2021 (CAA) provides a schedule for upcoming changes to coverage. At issue are cases like you’ve described, when the beneficiary presents for a screening colonoscopy (with no history or symptoms), but the surgeon finds a polyp or anomaly and takes a surgical specimen for pathological diagnosis. Look back: The problem in such a scenario has been that Medicare covers screening colonoscopy at 100 percent, but has cost sharing for diagnostic colonoscopy (when the surgeon finds something and takes a specimen), including deductibles and copays. That results in unexpected billing to the patient. To rectify this, CMS is implementing the following schedule to waive Medicare coinsurance for these colorectal cancer screening tests by gradually increasing coverage percentage as follows:
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