22-265m Avoid Claims Issues for Colorectal Cancer Screenings

Date: 04/08/22

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

Reminder: Be sure to bill preventive colonoscopies with  modifier 33

California Assembly Bill 342, effective January 1, 2022, addresses preventive colorectal cancer screenings and applies to grandfathered and non-grandfathered plans. The bill:

• Does not allow in-network cost sharing for colorectal cancer screening tests assigned either a grade A or B by the United States Preventive Services Task Force (USPSTF).
• Removes cost barriers to help catch cases of colorectal cancer earlier.
• Requires all health plans to cover in-network colorectal cancer screening tests in full.
• Includes a required colonoscopy due to a positive test result on a preventive colorectal cancer screening test or procedure, other than a colonoscopy.

Health Net recognizes the importance of preventive services to improve patient outcomes through screening and early detection of serious conditions. We urge providers to submit the correct billing requirements to avoid claim issues for preventive colonoscopies.

Billing requirements

In-network preventive colonoscopies are covered benefits with no cost sharing when billed with modifier 33.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center within 60 days, by phone or through the Health Net provider website.