Colonoscopies
Applies to
All products
Medical policy
- Colorectal Cancer Screening - 91547
Colonoscopies billing
Covered codes
See the medical policy for a list of covered ICD-10 codes and CPT/HCPCS procedure codes.
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 (including Cologuard and Fecal Occult Blood (FOB)) or direct visualization screening test, we cover this follow-up procedure and any resulting biopsies or pathology as preventive, without member cost share.
If you’re billing for a follow-up colonoscopy that meets the requirements noted above, you should:
- Bill as diagnostic, as you would normally
- Add modifier PT or 33 to indicate that it’s preventive
See the medical policy for the list of codes that, when billed with modifiers PT or 33, will process as a preventive benefit.
Prior authorization
Prior authorization is only required for the Computed Tomography Colonography (CTC) type of colonoscopy. All other types don't require prior authorization.
- In-network providers: Use our online Auth Request tool
- Out-of-network providers: Use our Medical Prior Authorizations form