Medicare AdvantageBilling CodesHigh impact
Louisiana House Bill 1196: Preventive Colonoscopy Services and Claims Submission Requirements
Ambetter·LA · Gastroenterology, General Surgery, Internal Medicine·Claims & Billing
Effective date
Aug 1, 2026
We identified it
Aug 26, 2026
Summary
Louisiana House Bill 1196 requires providers to use appropriate preventive screening modifiers when billing for colonoscopy services effective August 1, 2026. This includes preventive screening colonoscopies with polyp/tissue removal and provider-recommended follow-up screening colonoscopies performed per NCCN guidelines. Claims submitted without the correct preventive modifiers may not process as intended and could be denied.
Action Required
By July 31, 2026: Billing team must implement the following changes for Louisiana Healthcare Connections claims: (1) Update billing software to require appropriate preventive screening modifiers on all colonoscopy claims that qualify as preventive services; (2) Create internal guidance document identifying which colonoscopy procedures require preventive modifiers based on NCCN clinical guidelines; (3) Update claim submission templates and encounter forms to prompt providers to flag colonoscopies as preventive when applicable; (4) Train billing staff on modifier requirements and preventive vs. diagnostic colonoscopy distinction; (5) Implement claim audit process to catch claims submitted without required modifiers before submission. Consequences: Claims submitted without appropriate preventive screening modifiers will not process as intended and may be denied or delayed, impacting reimbursement and requiring rework.