MedicaidBilling CodesMedium impact
23-537m Bill Preventive Colonoscopies with Correct Modifiers for No Cost Share Benefits
Health Net·CA · Gastroenterology, Family Medicine, Internal Medicine·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
California Assembly Bill 342 requires providers to use modifier 33 when billing colorectal cancer screenings to ensure zero cost-sharing for patients. This applies to follow-on colonoscopies after positive non-invasive screening tests and lowers the screening age from 50 to 45 years for USPSTF grade A/B preventive services.
Action Required
Immediately: Billing team must add modifier 33 to all colorectal cancer screening CPT codes for Medi-Cal patients to ensure zero cost-sharing. Update billing software rules to automatically append modifier 33 for CRC screenings including colonoscopies, FIT tests, sDNA-FIT, CT colonography, and flexible sigmoidoscopy. Update age eligibility in system from 50 to 45 years for preventive screenings. Failure to use correct modifier will result in patient cost-sharing issues.