The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Colorectal Cancer Screening:
|81528 -||Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result|
|82270 -||Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided 3 cards or single triple card for consecutive collection)|
|G0104 -||Colorectal cancer screening; flexible sigmoidoscopy|
|G0105 -||Colorectal cancer screening; colonoscopy on individual at high risk|
|G0106 -||Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema|
|G0120 -||Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema|
|G0121 -||Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk|
|G0328 -||Colorectal cancer screening; fecal occult blood test, immunoassay, 1–3 simultaneous|
|G0464 -||Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., KRAS, NDRG4 and BMP3)|
For colorectal cancer screening using multitarget sDNA test:
All Medicare beneficiaries who fall into all of the following categories:
For screening colonoscopies, fecal occult blood tests (FOBTs), flexible sigmoidoscopies, and barium enemas:
All Medicare beneficiaries who fall into at least one of the following categories:
NOTE: “High risk for developing colorectal cancer” is defined in the Code of Federal Regulations (CFR) at 42 CFR 410.37(a)(3)
NOTE: Coverage of screening colonoscopies has no age limitation
For Beneficiaries Not Meeting Criteria for High Risk:
For Beneficiaries at High Risk:
No deductible for all surgical procedures (CPT code range of 10000 to 69999) furnished on the same date and in the same encounter as a screening colonoscopy, flexible sigmoidoscopy, or barium enema initiated as colorectal cancer screening services.
Append modifier -PT to CPT code in the surgical range of 10000 to 69999 in this scenario.
Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.
Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.
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