modifier 53

New Values for Incomplete Colonoscopies Billed with Modifier 53

An incomplete colonoscopy, e.g., the inability to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, is billed and paid using colonoscopy through stoma code CPT 44388, colonoscopy code CPT 45378, and screening colonoscopy codes CPT G0105 and CPT G0121 with modifier “-53.” (Code CPT 44388 is valid with modifier 53 beginning January 1, 2016.) The Medicare physician fee schedule database has specific values for codes CPT 44388-53, CPT 45378-53, CPT G0105-53 and CPT G0121-53. An incomplete colonoscopy performed prior to January 1, 2016, is paid at the same rate as a sigmoidoscopy. Beginning January 1, 2016,

Medicare will pay for the interrupted colonoscopy at a rate that is calculated using one-half the value of the inputs for the codes.

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