There
is age limit for both of Cologuard and CT Colonography (Virtual Colonoscopy) screening
test. None of these is applicable for patients whose age are below 50 or above
85. There is specific CPT and diagnosis codes for both of
them. This mandate of the USPSTF will come into force from January1,
2017. Let
see their common features below:
Features
of Cologuard:
Benefits: Contract benefits
once every three years.
Members: Members- adults
aged 50-75 or 76-85
Providers: IN Network &
Out of Network
Provider Type: Laboratory
CPT code: 81528(Oncology Colorectal Screening)
Primary
diagnosis codes:
Ø Z00.00(Encounter
for general adult medical examination without abnormal findings).
Ø Z00.01(Encounter
for general adult medical examination with abnormal findings)
Ø Z12.11(Screening
for malignant neoplasm)
Ø Z12.12(Screening
for malignant neoplasm of rectum)
Ø Z83.71
( Family History of Colonic Polyps)
Features
of CT Colonography(Virtual Colonoscopy)
Benefits: Contract benefits
once every five years.
Members: Members- adults
aged 50-75 or 76-85
Providers: IN Network &
Out of Network
Provider Type: Laboratory
CPT code: 74263(CT for Colonography Screening)
Primary
diagnosis codes:
Ø Z00.00(Encounter
for general adult medical examination without abnormal findings).
Ø Z00.01(Encounter
for general adult medical examination with abnormal findings)
Ø Z12.11(Screening
for malignant neoplasm)
Ø Z12.12(Screening
for malignant neoplasm of rectum)
Ø Z83.71
( Family History of Colonic Polyps)
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