Moderate Sedation with Colonoscopy


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We received a denial from United Healthcare for 99152. Their Claim/Coding Logic says: Not supported. This code is included in CPT code 43239,45380; therefore, it cannot be separately reimbursed.

We billed 99152 with a 59 modifier.

Does anyone know if UHC prefers G0500 instead of 99152? Also, is anyone using XU modifier and seeing reimbursement for 99152?

In reference to :
Effective January 1, 2017, the Centers for Medicare and Medicaid Services is separating moderate sedation services from hundreds of procedure codes, including the majority of GI endoscopy procedures under Medicare Part B.

Can anyone tell me why colonoscopy and moderate sedation still hit for an NCCI edit? What justification do we have to override that edit with modifier 59?

Thank you!