CMS’ first quarter update to HCPCS Level II codes included deletion of three codes to report colorectal cancer screening with barium enema. Coverage for these codes was halted and other coverage expanded as of Jan. 1, 2025.
All quarterly updates to HCPCS Level II codes and modifiers can be found at this link to the CMS website: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update.
Medicare has decided to remove coverage for barium enema as a method of screening for colorectal cancer, and delete the corresponding HCPCS Level II codes, due to rare use among Medicare beneficiaries. Additionally, this exam is no longer being recommended as an evidence-based method of screening given the advancement of alternatives such as stool-based tests, colonoscopies, and CT colonography. The codes that have been deleted include the following:
In response to updating coverage policies to better reflect current medical practice Medicare is expanding coverage to include other methods of screening for colorectal cancer.
For example, CMS is following the recommendation of The U.S. Multi-Society Task Force of Colorectal Cancer (MSTF) which states, “ …CT colonography has replaced double-contrast barium enema as the test of choice for colorectal imaging for nearly all indications. CT colonography is more effective than barium enema and better tolerated.”
Coverage updates include adding CT colonography as a covered service and making follow-on screening colonoscopy after a positive blood-based biomarker test part of the continuum of screening.
Note that CMS did not add coverage for the multi-target mRNA stool test called Colosense.
Organizations will want to ensure any relevant hard coding processes and/or EHR features reflect the deletion of these codes.
Please visit the following HIA resources for additional instruction in outpatient coding for colonoscopy procedures:
References
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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.