Patient Age Can Be an Issue for Coverage

Why This Topic Matters

Understanding age- and risk-based screening coverage rules helps practices anticipate denials and handle patient responsibility appropriately. The article is useful for anyone coding or billing colorectal cancer screening services under Medicare.

Article Sections

1. Medicare screening coverage and age considerations

   This section discusses general Medicare screening coverage for colorectal cancer and how beneficiary age and risk status affect eligibility considerations. It also references a Medicare guidance source related to high-risk screening coverage.

2. Example involving a repeated screening exam

   This section presents an example of a screening exam that is repeated after an unsuccessful attempt and explains the billing context for the subsequent service. It references a Medicare transmittal as supporting material.

3. Turn to ABN When Exceeding Frequency Limits

   This section explains what happens when a patient requests a screening service outside Medicare screening expectations and discusses the use of an advance beneficiary notice. It also notes Medicare billing and patient-notification considerations when coverage is likely to be denied.