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    Health Service Code 01.22A

    Other nonoperative colonoscopy for screening of high risk patients

    NOTE:
    1. HSCs 57.13A, 57.21A, 57.21B, 57.21C and 58.99C may be claimed in addition.
    2. Benefit includes biopsies.
    3. Benefit includes the removal of diminutive polyps that are 5mm or less in size.
    4. May be claimed for screening purposes for those patients that have been considered to be of high risk for colon cancer.
    5. High risk is defined as an individual that has a strong family history of colorectal cancer with multiple individuals affected but no genetic syndrome identified, family history of Hereditary Non-Polyposis Colorectal Cancer or a personal history of inflammatory bowel disease.
    6. May be claimed once every year.
    Category:M+ Designated Minor Procedure
    Base rate:$180.21

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$110.43
    ROLEANESTYesReplace Base$18.39
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LVPLVP75YesReduce Base To75%

    Governing Rules: