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Experience. Integrity. Advocacy.

Medicare Redefines Screening Colonoscopies for 2015

Patient in the operation theatre

Starting with January 1, 2015, dates of service, anesthesia provided by a separate anesthesia profession during screening colonoscopies will be paid at 100 percent of the Medicare Fee Schedule by Medicare and will not be applied to the deductible or coinsurance.

This redefining of screening colonoscopies reflects changes in the standard of care and shifting practice patterns toward increased use of anesthesia in conjunction with screening colonoscopy observed by the Centers for Medicare and Medicaid Services (CMS).

To receive full Medicare payment of anesthesia services during a screening colonoscopy, anesthesia professionals should use CPT 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum) on the claim line along with the 33 modifier.

For screening colonoscopies that end with a polyp or other growth removed, beneficiaries are responsible for Part B coinsurance for the diagnostic colonoscopy, and similarly, any Part B coinsurance for any covered anesthesia. However, the deductible will be waived for the screening test, including the anesthesia services furnished in conjunction with the colorectal cancer screening test, even when a polyp or other tissue is removed during a colonoscopy. In these cases, the anesthesia professional should report a PT modifier on the claim line rather than the 33 modifier.

For more information about these changes, review the display copy of the 2015 Medicare Physician Fee Schedule.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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