Nov. 23, 2022

Colonoscopy Coverage Changes for Grandfathered Plans
Applies to grandfathered group plans

Earlier this year, the federal government released updated guidance around preventive colonoscopy coverage. Blue Cross and Blue Shield of Oklahoma (BCBSOK) is updating our plan benefits to match that guidance, which changes how certain types of colonoscopies and related services are covered.

What you need to know:
The FAQs about Affordable Care Act Implementation Part 51  requires that colonoscopies be covered as preventive after a positive non-invasive stool-based or direct visualization screening test. As a result, we’re adding two diagnosis codes to the list of colonoscopy services covered as preventive:

• R19.5 Other fecal abnormalities
• K63.5 Polyp of colon

What is changing?
Since Grandfathered plans don’t have to cover all preventive services without cost sharing, these two codes will be treated the same way a Grandfathered plan currently covers preventive colonoscopy services:

• Plans that cover routine colonoscopies as a standard medical benefit will cover these codes subject to applicable cost sharing.
   
• Plans that cover routine colonoscopies without cost sharing will cover these codes without cost sharing.

When does this go into effect?
These codes will be covered as preventive starting Feb. 13, 2023, regardless of renewal date.

What do groups need to do?

• Groups who don’t want to make changes to their colonoscopy benefits don’t need to do anything.
   
  Groups that cover routine colonoscopies without cost sharing but want to cover these two codes with applicable cost sharing should let their BCBSOK account representative know before Jan. 15, 2023.