In the final Physician Fee Schedule rule for 2015, CMS applied the cost-sharing waiver to anesthesia for screening colonoscopies; however, diagnostic and therapeutic colonoscopies are still subject to co-payments and deductibles, according to an Anesthesia Business Consultants blog post.
Additionally, Medicare waives the deductible for colonoscopies that are intended as purely preventive but during which the endoscopist ends up removing a polyp or tissue for biopsy, but the patient is still responsible for the co-payment. There are also two different modifiers (-33 and -PT) that must be reported on the claim for the anesthesia service that further add to the confusion.
Also, while CMS has clearly described the use of the modifiers, the instructions given to the Medicare Administrative Contractors did not contain the necessary information on modifier -PT.
The situation becomes even more confused with private health plans that not constrained by the barring of patient deductible waivers for colonoscopies that turn diagnostic or therapeutic. But private health plans vary in whether they recognize modifier -33 for anesthesia for any colonoscopies at all.
According to Anesthesia Business Consultants, the Patient Protection and Affordable Care Act principle that requires health plans to provide first-dollar coverage for colorectal cancer screening tests, waiving any patient co-insurance, co-payments or deductible amounts, should apply whether or not the procedure turns diagnostic or therapeutic.