tci General Surgery Coding Alert - 2008 Issue 6

Patient Age Can Be an Issue for Coverage

Medicare guidelines generally require that a screening exam is a covered benefit for Medicare beneficiaries at low risk for colorectal cancer only for those patients 50 years of age or older. This can vary, however, and some carriers specify medical-necessity requirements that allow low-risk beneficiaries under age 50 to receive a covered screening exam. For beneficiaries at high risk for colorectal cancer, national Medicare policy does not set a minimum age requirement. "For beneficiaries considered to be at high risk for developing colorectal cancer, Medicare covers one screening colonoscopy every two years, regardless of age," according to MedLearn...

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