What defines a screening colonoscopy and a surveillance colonoscopy?
Screening colonoscopies are performed on patients who have NO symptoms and NO personal history of colon polyps or colon cancer. Medicare and most insurance carriers will pay for screening colonoscopies once every 10 years.
Surveillance colonoscopies are performed on patients who have a prior personal history of colon polyps or colon cancer. Medicare will pay for these exams once every 24 months. Patients are placed in SETGA’s Recall program to return for follow-up surveillance colonoscopy based on the type of polyp or neoplasm found and at the direction of the physician.
A family history but no personal history of colon polyps or colon cancer is sometimes considered surveillance and does not fall under screening benefits. It depends on the insurance carrier. It must be verbally verified with the insurance carrier.
The benefits quoted to this office by your insurance carrier come from Provider Services. Benefits quoted to you by your insurance carrier come from Member Services. The information quoted is based on the information provided and is not a guarantee of payment. We will be happy to provide you with the procedure and diagnosis codes based on the procedure SCHEDULED. We encourage you to contact your insurance carrier as well to confirm your benefits and notify our office of any discrepancy in order to resolve the discrepancy BEFORE YOUR PROCEDURE. The estimated patient amount due that is quoted to you by our office is an ESTIMATE based on the procedure SCHEDULED. The procedure may require additional services, if biopsies are taken or polyps removed, etc., and your insurance carrier will be billed for the ACTUAL SERVICES performed. Most insurance carriers will provide screening benefits if you were scheduled for a screening colonoscopy, even if your procedure requires the additional services. You will be billed by our office for the balance due after your insurance company has processed your claim and made payment.