New billing guidance for follow-up colon cancer screenings

When one of our members requires a follow-up colonoscopy after a positive, non-invasive stool-based screening test or direct visualization screening test, we cover this follow-up procedure and any resulting biopsies or pathology without member cost share.

How should you bill the follow-up test?

If you’re billing for a follow-up colonoscopy that meets the requirements noted above, you should:

  1. Bill as diagnostic, as you would normally
  2. Add modifier PT or 33 to indicate that it’s preventive

Find coding guidance for colorectal cancer screenings.