Wiki Medicare CRC Screening: Diagnostic Modifier-PT

[VFarrell]

Does this mean that MCR will pay at the lower rate of just a screening? And do we use this modifier with all insurance companies or just Medicare?

 

[smrgr]

No this means if you perform a polypectomy etc. on a patient who presented for a screening colonoscopy the Medicare deductible will be waived. Under the Affordable Care Act if they only have a screening colon G0105, or G0121 then they have the deductible and coinsurance waived. This way the patients who have a polyp etc found will also benefit from the waived deductible. We have problems with our carrier processing 45385 etc. with a V code so we have no way of indicating when the patient presented for a screening that turned diagnostic.