CommercialBilling CodesMedium impact
23-538m Bill Preventive Colonoscopies with Correct Modifiers for No Cost Share Benefits
Health Net·CA · Gastroenterology, General Surgery, Family Medicine +1 more·Reimbursement
Effective date
Jun 30, 2023
We identified it
Jun 20, 2026
Summary
Healthcare providers must use correct modifiers when billing colorectal cancer screening colonoscopies to ensure patients receive no cost share benefits. This policy emphasizes proper modifier usage for preventive colonoscopy billing to avoid patient cost sharing issues.
Action Required
Immediately: Billing team must review and ensure correct modifiers are being used for all colorectal cancer screening colonoscopies. Download the Provider Update PDF from the HealthNet provider library for specific modifier requirements. Verify billing software applies appropriate modifiers to prevent patient cost sharing for preventive screenings.