CommercialBilling CodesHigh impact
22-265m Avoid Claims Issues for Colorectal Cancer Screenings
Health Net·CA · Gastroenterology, General Surgery, Family Medicine +1 more·Reimbursement
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net requires preventive colonoscopies to be billed with modifier 33 to ensure no cost-sharing for patients under California Assembly Bill 342. This applies to all USPSTF grade A or B colorectal cancer screening tests and follow-up colonoscopies after positive screening results.
Action Required
Immediately: Billing team must ensure all preventive colonoscopies are billed with modifier 33 to avoid claim issues and ensure proper coverage with no patient cost-sharing. Update billing system rules and encounter forms to require modifier 33 for all preventive colonoscopy procedures. Train staff that this includes colonoscopies performed due to positive results from other preventive colorectal screening tests.