DEFINITION
Gastroenterology is the study, diagnosis and treatment of disorders of the digestive system. These disorders may affect the esophagus (swallowing tube), stomach, small intestine, large intestine (colon), rectum, liver, gallbladder or pancreas.
GENERAL BENEFIT INFORMATION
Services and subsequent payment are based on the member's benefit plan document. Providers and their office staff should use self-service channels to verify effective dates and copayments for members prior to initiating services.
Tufts Medicare Preferred HMO
Tufts Medicare Preferred HMO follows Medicare coverage guidelines. Tufts Health Plan cannot cover items and services not covered under the CMS-approved Tufts Medicare Preferred HMO benefit plan. Tufts Medicare Preferred HMO’s benefit plan currently covers a limited number of non-Medicare covered items as supplemental benefits.
Note: Supplemental benefits are subject to change each year.
Tufts Health Plan Senior Care Options
Tufts Health Plan Senior Care Options follows Medicare coverage guidelines for Medicare-covered benefits and Medicaid coverage guidelines for Medicaid-only covered benefits.
MEMBER RESPONSIBILITY
Copayments deductible and/or coinsurance may apply for commercial and Tufts Medicare Preferred HMO members pursuant to the member’s benefit plan specifics.
Note: Colonoscopies accompanied by treatment/surgery (e.g., polyp removal) may be subject to the day surgery copayment.
Tufts Health Plan Senior Care Options members have no member copayment, coinsurance or deductible responsibility.
Tufts Health Plan recommends not billing the member for the coinsurance and/or deductible amount until the claim has processed so that the appropriate member responsibility can be determined. Both the provider’s Explanation of Payment (EOP) and the Electronic Remittance Advice (ERA) will reflect the member’s responsibility amount.
Note: Tufts Health Plan will not allow the use of a so-called "waiver" to circumvent or override the provider's obligations under the applicable participation agreement with regard to services covered under the member's plan. By way of illustration and not limitation, the waiver is of no validity when applied to missed filing deadlines, provider's authorization requirements and attempts to collect payments other than applicable copayments, coinsurance or deductibles.
Learn about Colonoscopy and Endoscopy billing procedure methodologies. GI gastrointestinal endoscopy and colonoscopy preparation, complication and what happened after the process. How to do the correct billing. EGD, GI and Screening CPT codes.
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Most read colonoscopy CPT codes
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CPT CODE 49082 - Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance -Average fee amount $200 CPT CODE 49083 - ...
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EGD - Procedure Most used CPT code list and description 43235 EGD diagnostic Fee schedule amount $ 310.8 43239 EG...
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CPT Code Description 47562 Laparoscopy, surgical; cholecystectomy - Average fee amount - $600 - $750 47563 - Laparoscopy, surgical; c...
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Colonoscopy Billing tips - cpt 45380 45385 As a speaker at many national conferences, I find the question most frequently asked is, ...
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Skip 46930 with Revised Hemorrhoidectomy Codes Make sure you’re not reporting destruction of internal hemorrhoids by thermal energy with ...
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EGD CPT CODES COVERED ICD-10 Codes that Support Medical Necessity B25.2 Cytomegaloviral pancreatitis B37.81 Candidal esophagitis C15.3...
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Flexible Sigmoidoscopy Specific instructions for reporting flexible sigmoidoscopy have been added to the section guidelines. Report flexib...
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Argon Plasma Coagulation Argon plasma coagulation: A non-contact thermal technique which uses ionized argon gas to deliver a high-frequenc...
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97010 - Application of a modality to 1 or more areas; hot or cold packs Average fee amount $5 -$10 97012 - Application of a modality to 1 ...
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Diagnostic and Therapeutic Esophagogastroduodenoscopy CPT/HCPCS Codes 43233 Egd balloon dil esoph30 mm/> 43235 Egd diagnostic br...

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