Is CPT code 45378 preventive?

What all is considered preventive care?

What is the CPT code for Medicare preventive visit?

G0402: This code applies to the Welcome to Medicare visit — also referred to as an Initial Preventive Physical Exam (IPPE).

Is a colonoscopy preventive or routine?

While screening colonoscopies are key to catching problems in their earliest stages before symptoms arise, a diagnostic colonoscopy is necessary when symptoms are already present. Screening or diagnostic approaches are even more important if you have a personal risk of colorectal cancer or certain medical conditions.

Why is my colonoscopy not covered by insurance?

Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a “screening” test if a polyp was removed during the procedure. It would then be a “diagnostic” test, and would therefore be subject to co-pays and deductibles.

Is colonoscopy considered primary prevention?

In addition to lifestyle modification, it is also important to note that colonoscopy, while generally considered as part of screening (or secondary prevention), may also play a part in primary prevention since removal of noncancerous polyps from the colon may prevent CRC from starting in the first place [18].

What is CPT 45378?

Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Is a colonoscopy considered preventive care in United Healthcare?

A: Yes, in this situation, the colonoscopy would be considered under the preventive care services benefit when billed in accordance with the coding in the Colorectal Cancer Screening row listed in this policy.

What is not considered preventive care?

ANSWER: If the physician orders lab work during a preventive care visit, some of the tests may be covered as preventive care, such as a cholesterol screening. However, other blood chemistry panels, such as anemia screening, kidney or liver function, would not be covered as preventive care.

Does Medicare accept 45378?

If a polyp or lesion is found during the screening procedure, the colonoscopy becomes diagnostic and should be reported with the appropriate diagnostic colonoscopy code (45378-45392). For Medicare patients, the PT modifier would be appended to the code to indicate that this procedure began as a screening test.

What is the difference between preventive colonoscopy and diagnostic colonoscopy?

Diagnostic colonoscopies, also referred to as follow-up or surveillance colonoscopies, are different from screening colonoscopies since such procedures are provided when there is a greater probability of cancer development or if there is evidence that colorectal cancer might be present.

Can you use modifier 33 on 45378?

Screening colonoscopy (no polyps removed)

NOTE: You must add modifier 33 (preventative services) to CPT code 45378 for patients with commercial insurance to prevent them from being inappropriately billed.

Is colonoscopy covered under preventive care?

The Affordable Care Act requires recommended preventative services, such as colonoscopies, be covered at no cost to the patient. However, strict guidelines are used by insurance companies to determine whether a colonoscopy is categorized as preventative or diagnostic, which can impact your potential out of pocket cost.

How much is a colonoscopy without insurance?

Without insurance, a colonoscopy in the U.S. can range from $1,250 to $4,800 or more with an average cost of $2,750. If you have insurance, you typically pay nothing for a screening colonoscopy.

How early will insurance cover colonoscopy?

Computed tomographic colonography (CT colonography) is covered once every 5 years beginning at age 45 for individuals at average risk for colon cancer.

At what age is a colonoscopy considered preventive?

Screening recommendations

The US Preventive Services Task Force (Task Force) recommends that adults age 45 to 75 be screened for colorectal cancer. The decision to be screened between ages 76 and 85 should be made on an individual basis. If you are older than 75, talk to your doctor about screening.

Do you have to pay a deductible for a colonoscopy?

If your insurance denies or does not cover monitored anesthesia care, you may have to pay a flat fee of $200. If your insurance covers monitored anesthesia care for a diagnostic colonoscopy, you may still have to pay for co-insurance and deductibles, which may be higher than $200 based on your insurance policy.

What is the easiest colonoscopy prep to tolerate?

Bowel preps that combine an osmotic laxative with another type of laxative, including MiraLAX, Halflytely and Prepopik, may be better tolerated with fewer side effects. Taking your bowel prep with adjunct agents.

What labs are considered preventive?

Certain STI tests, like HIV, hepatitis B and C and syphilis are considered preventive for people at certain ages or with specific risk factors.

Is bloodwork part of a wellness visit?

Does a Wellness Exam Include Blood Work? Yes, a wellness exam can include blood work. However, it's important to note that the specific tests conducted during a wellness exam may vary from person to person.

What preventive services are not covered by Medicare?