Colon Cancer Screening
Requirements
HMO/POS
Referrals are required from Primary Care Physician to a Contracting Provider.
Services subject to benefit limitations.
PPO/PBA
Services are subject to benefit limitations.
Limitations and Exclusions
Limitations:
Colorectal cancer screening, which includes:
Fecal occult blood (age 50 or older) annually if not part of the annual well-woman exam; and
Barium enema or Sigmoidoscopy (age 50 or older) once every five (5) years; or
Colonoscopy (age 50 or older) once every ten(10) years.
Provider Billing Guidelines and Documentation
In order for Claims to be processed to the Preventive Service Benefit, the provider must submit with the following diagnosis and service codes:
Code | Description | ||||||||||||||||||||||||||||
V12.72 | Personal History of Colonic Polyps | ||||||||||||||||||||||||||||
V16.0 | Family History of Malignant Neoplasms of Gastrointestinal Tract | ||||||||||||||||||||||||||||
V70.0 | Routine General Medical Examination at a HealthCare Facility | ||||||||||||||||||||||||||||
V70.9 | Unspecified General Medical Examination | ||||||||||||||||||||||||||||
V72.85 | Other Specified Examination | ||||||||||||||||||||||||||||
V72.9 | Unspecified Examination | ||||||||||||||||||||||||||||
V76.49 | Special Screening for Malignant Neoplasms, Other Sites | ||||||||||||||||||||||||||||
V76.50 | Special Screening for Malignant Neoplasms, Unspecified Intestine | ||||||||||||||||||||||||||||
V76.51 | Special Screening for Malignant Neoplasms, Colon | ||||||||||||||||||||||||||||
V76.52 | Special Screening for Malignant Neoplasms, Small Intestine | ||||||||||||||||||||||||||||
V76.89 | Special Screening for Malignant Neoplasm | ||||||||||||||||||||||||||||
V76.9 | Screening for Unspecified Malignant Neoplasms |
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