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    Health Service Code 01.22B

    Other nonoperative colonoscopy for screening of moderate 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 moderate risk for colon cancer.
    5. Moderate risk is defined as an individual who has one or more first degree relatives with colorectal cancer or personal history of colorectal adenomatous polyps.
    6. May be claimed once every 5 years.
    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: