2014-09-16 13:44:54 UTC

AGA Asks CMS to Clarify Colonoscopy Cost-Sharing Requirements

Sept. 18, 2014

AGA has requested that CMS clarify that a colonoscopy resulting from a positive fecal occult blood test or fecal immunochemical test is part of a continuum of care for colorectal cancer screening. Therefore, patients should not be charged for the screening colonoscopy.

AGA, in collaboration with ASGE and ACG, sent a letter to CMS asking for guidance on colonoscopy cost-sharing requirements for Medicare beneficiaries after a positive fecal occult blood test (FOBT) or fecal immunochemical test (FIT). The request was in response to an Aug. 18 meeting during which GI society representatives discussed the matter with CMS officials.  

Confusion has arisen among payors and providers due to ambiguities in Medicare language that waives cost-sharing for screening colonoscopies. The letter asks CMS to clarify that a colonoscopy qualifies as a “screening” colonoscopy if it is performed as a result of a beneficiary’s positive FOBT or FIT test. In the letter, AGA argues that a colonoscopy is the natural result of a positive FIT or FOBT test and is part of the same continuum of care, which makes the follow-up colonscopy part of the initial “screening.” The letter asks CMS to provide official guidance on the issue to avoid confusion and unexpected cost-sharing liabilities for Medicare beneficiaries.  

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