Colonoscopy Claim Submissions

Date: 08/31/22

A Message for Ambetter Providers. Please share with your Billing team.

In order to ensure that preventative colonoscopies are being billed with the correct member cost share, we are providing some resources below related to possible billing scenarios.

Please review the following articles and guidance regarding colonoscopy billing requirements:

• CMS Article: Billing and Coding: Screening Colonoscopy Converted to a Diagnostic and/or Therapeutic Colonoscopy
• CMS Publication: Medicare Claims Processing Manual, Chapter 18, Sections 60-60.3
• U.S. Preventative Services Task Force Recommendations for Colorectal Cancer Screening

If you have questions about this bulletin or other provider resources, please contact Provider Relations via the Contact Us page or call Provider Services at 1-844-518-9505 (TTY 711).