CMS Guidance For Anesthesia For Screening Colonoscopies

Update: CMS has issued updated guidance to practitioners on anesthesia associated with screening colonoscopy.

The Centers for Medicare and Medicaid Services (CMS) has issued additional guidance to its contractors about processing claims for anesthesia for screening colonoscopy. This new information includes resolution of the previously identified problem in processing claims for anesthesia for screening colonoscopy that becomes diagnostic as reported with anesthesia code 00810 and the PT modifier.

On May 5, 2015, Palmetto GBA posted the following notice:

“For services submitted on or after January 1, 2015, Part B! Medicare Administrative Contractors will update their claims processing! systems to allow CPT code 00810 for anesthesia services when billed with CPT modifier 33. The Medicare deductible and coinsurance will be waived even if HCPCS codes G0105 or G0121 screening colonoscopy service is not in history). The Medicare deductible will be waived for CPT code 00810 anesthesia services billed with HCPCS modifier PT. Adjustments for the denied claims are being initiated by Palmetto GBA and payment will be made within 45 days. Please share with appropriate staff.”

We anticipate similar notice and action from other CMS contractors. ASA had been in contact with CMS staff on this matter and we appreciate their assistance in resolving this issue. 

Previous ASA Alerts

• CMS to Implement Fix for Anesthesia Payments for Colonoscopies
• Denials of claims for anesthesia for screening endoscopy that becomes diagnostic (Code 00810 with modifier PT)
• Coding Guidance for Anesthesia for Screening Colonoscopy
• 2015 Physician Fee Schedule Final Rule Issued; Important News About Anesthesia for Colonoscopy, Pain and PQRS