Pre-procedure Consultations for Colorectal Cancer Screening Procedures (revised 01/22/2020)




    Policies Impacted

    00.06.02ac Preventive Care Services (AH)

    Purpose

    This communication provides advance notice regarding a change in coding requirements for pre-procedure consultation for colorectal cancer screening procedures.

    Background

    A consultation is a type of service provided by a physician or other qualified healthcare professional whose opinion or advice regarding the evaluation and management (E/M) of a specific clinical problem is requested by another physician or other qualified healthcare professional.

    During a pre-procedure consultation for colorectal cancer screening procedures, the provider assesses an individual's health status and explains the benefits and risks of the procedure.

    Coverage Statement

    Effective April 15, 2020, Current Procedural Terminology (CPT) consultation codes are not eligible for reimbursement. An appropriate level of Evaluation and Management (E&M) service should be reported (e.g., pre-procedure consultation for screening flexible sigmoidoscopy or CT colonography).

    Pre-procedure consultation for colorectal cancer screening procedure is covered as a preventive service for individuals who are eligible for coverage of a colorectal cancer screening procedure when the attending provider determines that the pre-procedure consultation will be medically appropriate.

    Coding

    99241, 99242, 99243

    Issued on - 12/30/2019