Preventive Colonoscopy: New Frequently Asked Questions Added

In September 2012, we published the Blue Review article, BCBSTX automates claims processing for preventive colonoscopies . 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 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.