Use new modifier PT when a colorectal screen becomes a diagnostic service

Why This Topic Matters

The guidance affects how colorectal screening claims are reported and how patient financial responsibility is handled when a preventive service changes course during the encounter. It also distinguishes Medicare-specific billing instructions from broader preventive-service coding guidance used by other payers.

Article Sections

1. CMS policy update for colorectal screening services

   Introduces the Medicare policy change, the effective date, and the general billing impact for screening services that become diagnostic or therapeutic.

2. Transmittal 739 and modifier PT

   Summarizes the CMS transmittal and the new HCPCS modifier used in connection with colorectal screening services that convert during the encounter. It also notes the related scope of certain surgical procedures in the same encounter.

3. Example and diagnosis reporting guidance

   Provides an illustrative claim scenario and a brief note about diagnosis sequencing in the context of the screening encounter.

4. Cost-sharing treatment when the screening does not convert

   Discusses preventive-service payment treatment when the screening remains preventive and does not change to a diagnostic service.

5. Modifier 33

   Introduces the AMA preventive-service modifier and describes its broader preventive-service scope compared with the Medicare-specific guidance.