Office Consultation for Screening Colonoscopy - MVP Health Care
November 1, 2018 -- #44E
Office Consultation for Screening Colonoscopy
An office consultation is usually not necessary prior to a screening colonoscopy. The medical literature has failed to demonstrate differences in health outcomes for patients that have a consultation prior to colonoscopy compared to patients who do not have a consultation visit. MVP Health Care (MVP) members do not currently have a cost share responsibility for a screening colonoscopy. According to federal and state guidelines, an office visit which is provided primarily to address issues related to a screening colonoscopy would also be considered preventive and member cost share (copayment, coinsurance, or apply to a deductible) does not apply. MVP's Preventive Health Care Payment Policy includes the following coding rules for a consultation prior to screening colonoscopy:
? When performing a consultation prior to a screening colonoscopy, Code S0285 (colonoscopy consultation performed prior to a screening colonoscopy procedure) should be billed and will not charge a member cost share.
? Evaluation and Management codes should not be used when billing a consultation prior to a screening colonoscopy. These codes will charge a member cost share and should only be used if the predominant reason for the visit is not for the screening colonoscopy.
Effective 2/1/19, MVP will reimburse for S0285 at the provider's contractual rate for CPT code 99212. Consistent with Medicare guidelines, code S0285 will not be reimbursed separately for Medicare product lines.
If you have any questions with respect to this notice, please contact your Professional Relations Representative.
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