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ConnectiCare will cover pre-colonoscopy visits as preventive for commercial plan members

01/04/2016

ConnectiCare will cover medically appropriate pre-colonoscopy provider visits as preventive care when the visit is billed with the appropriate codes. This is effective immediately for ConnectiCare’s commercial plan members.

Doctors should not ask your ConnectiCare patients to pay anything out of pocket – copayment, deductible or coinsurance – for these visits. If you collect any payments from eligible members for medically appropriate pre-colonoscopy visits after Jan. 1, 2016, please refund those payments to your patients, our members.

This policy reflects our commitment to making it easy for our members to get the care they need and improving screening rates for colorectal cancer.

Please note this policy:

  • Applies to all ConnectiCare members in group and SOLO plans as well as plans sold to individuals on Access Health CT, the state insurance marketplace.
  • Does not apply to members with ConnectiCare Medicare VIP plans.
  • Only applies when the provider visit is done by the gastroenterologist performing the procedure and is billed with the right codes as listed below:
Preventive Service Procedure Code ICD-9/ICD-10 Pairing Guidelines
Colonoscopy, pre-procedure screening with a gastroenterologist 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 Z01.818 Frequency: 1x/year
Age Band: 50-75 years
Gender: M/F

For more information about preventive services, check out A Provider's Guide to Preventive Health Services for Your Patients.