sglasener
New
Is everyone following the CMS guidelines and coding the Colonoscopies after a positive cologuard as screening even if the have commercial Insurance? Thank you
Are your commercial carriers applying benefits at 100% of the network allowance with no member cost-sharing, assuming you are in-network with the carriers, when you are billing with the KX modifier?Our coding team has been following CMS rule for all payors since earlier 2023 when the final rule was implemented. I have seen that the modifier usage may be different for Commercial/Medicaid versus Medicare (KX versus 33). For now, we are appending Mod KX to these types of colonoscopies.
I cannot comment on insurance types, mod KX usage and cost-sharing. I have reviewed current denials and did not find any issue with the KX modifier.Are your commercial carriers applying benefits at 100% of the network allowance with no member cost-sharing, assuming you are in-network with the carriers, when you are billing with the KX modifier?
Also, have you seen any guidance on any type of time frame for when the follow-up colonoscopy has to be performed after the positive/abnormal FOBT or Cologuard test?
I would assume that since a screening FOBT frequency limits is “once every 12 months (i.e., at least 11 months have passed following the month in which the last covered screening FOBT was performed).”; that this could be the time period, that the results are good for.