Article Detail - JE Part B
Colorectal Cancer Screening Test: Reduced Coinsurance for Related Procedures Begins January 1
Currently, planned colorectal cancer screening tests are free. However, if you add a procedure in the same clinical encounter as a result of the colorectal cancer screening, the patient pays a coinsurance. Beginning January 1, 2023, CMS will gradually reduce coinsurance for procedures performed in connection with a colorectal cancer screening test, as a result of a screening test, or in the same clinical encounter as the screening test. The reduced coinsurance applies regardless of the code you bill.
Effective January 1, 2022, when a screening colorectal cancer procedure, G0104, G0105, or G0121 has the PT modifier submitted on the claim line item with HCPCS codes 10000 - 69999, G0500, 00811, or CPT code 99153 for diagnostic colonoscopy, or diagnostic flexible sigmoidoscopy, or other procedure to indicate that a screening colorectal cancer procedure, HCPCS G0104, G0105, or G0121, has become a diagnostic or therapeutic service, coinsurance is reduced or waived for claims for dates of service in Calendar Years (CYs) as follows:
- 2023-2026, coinsurance is 15%
- 2027-2029, coinsurance is 10%
- Beginning 2030, no coinsurance
Learn more about phasing out coinsurance in CMS MLN Matters (MM) 12656, Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter As Certain Colorectal Cancer Screening Tests.
Source: CMS MLN Connects dated November 23, 2022
