Preventive Colonoscopies: Updated FAQs and Article Clarification

November 30, 2012

On Sept. 15, 2012, we posted an article titled, "Processing Claims for Preventive Colonoscopies Now Automated". This article included five frequently asked questions (FAQs) about colorectal cancer screening via colonoscopy. In response to additional provider inquiries, we’ve updated these Preventive Colonoscopy Claim FAQs  with answers to the following new questions:

  • When a colonoscopy is performed to follow up on a previously identified abnormality, is it covered as a preventive service with no patient cost-share under the health care reform law?
  • How often can a patient be screened for colorectal cancer using colonoscopy without patient cost-sharing under health care reform?

Previous Article Clarification

The September article stated, “ACA requires that preventive services such as diagnostic colonoscopy be covered without member cost sharing when the member is covered by a non-grandfathered health care plan." The article also stated, “Accurate claims billing is essential to receiving correct payment for a preventive care service like a diagnostic colonoscopy.” Please note that the term “diagnostic colonoscopy” in these sentences refers to colorectal cancer screening using colonoscopy.