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    Health Service Code 01.22C

    Other nonoperative colonoscopy for screening of average 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 average risk for colon cancer.
    5. Average risk is defined as an individual that is asymptomatic and aged 50 to 74 years.
    6. May be claimed once every 10 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: