Removal of a NCD & Expansion of Coverage of CRC - Revised

Related CR Release Date: October 12, 2023
Effective Date: January 1, 2023
Implementation Date: February 27, 2023, November 13, 2023, for requirements subject to revision in the amended CR
MLN Matters Number: MM13017 Revised
Related Change Request (CR) Number: CR 13017
Related CR Transmittal Numbers: R12299CP, R12299BP, and R12299NCD

Note: CMS added clarifying information about the -KX modifier for screening colonoscopy claims in the context of a complete colorectal cancer screening. Substantive changes are in dark red (pages 2-3).

CR 13017 tells you about:

  • Removal of National Coverage Determination (NCD) 160.22 - Ambulatory Electroencephalographic (EEG) Monitoring
  • Lowering the minimum age for colorectal cancer screening (CRC) from age 50 to 45 for certain tests
  • Expanding the definition of CRC screening tests and new billing instructions for colonoscopies under certain scenarios
  • Medicare manual updates

Make sure your billing staff knows about these changes.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)13017.

Last Updated Nov 09 , 2023