Tricare billing update

 TRICARE Policy Update - Provider Information for Colonoscopy Referrals, Costs and Billing

To help differentiate a diagnostic colonoscopy from a routine colonoscopy screening it is important to include a diagnosis code related to the patient’s specific clinical condition. Referrals and claims submitted with only a “V.xx” diagnosis code, such as V76.50 or v76.51 may be considered as routine colonoscopy screening only.

The TRICARE (CHAMPUS) maximum allowable charge (CMAC) for any medical service depends on its complexity (as described by common procedural terminology [CPT] coding), the setting (primarily facility or non-facility), and the location (using regional ZIP-code methodology similar to that employed by Medicare). Actual provider payments will vary further depending on specific provisions within network agreements between individual providers and Health Net.