CurrentCareSourcePolicy N/A

Colorectal cancer screening and surveillance reimbursement for Arkansas PASSE

Defines reimbursement rules, required coding, and coverage conditions for colorectal cancer screening and surveillance services for CareSource members in the Arkansas PASSE program.

Policy Summary

PayerCareSource

PolicyColorectal cancer screening and surveillance reimbursement for Arkansas PASSE

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionSubmit screening and surveillance claims with appropriate ICD-10 screening codes and applicable HCPCS/CPT codes and modifiers; prior authorization is not required for participating providers.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

45minimum screening age

07/01/2024effective date

No PAparticipating providers

LimitedCT colonography

Colorectal Cancer Screening and Surveillance Coverage

Colorectal cancer screening and surveillance coverage criteria

Covered when ALL of the following age/risk, test, and documentation conditions are met:

ALL of the following

Age or risk
- Member is age 45 years or older (routine screening).
- Member is under age 45 but is at increased risk for colorectal cancer (screening/surveillance as indicated).
Covered screening and surveillance tests
- Highly sensitive fecal immunochemical test (FIT).

Policy Summary

PayerCareSource

PolicyColorectal cancer screening and surveillance reimbursement for Arkansas PASSE

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2024

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ICD-10 and Billing Coding Guidance

ICD-10 screening and history codesICD-10Covered

Z12.10	Encounter for screening for malignant neoplasm of intestinal tract, unspecified
Z12.11	Encounter for screening for malignant neoplasm of colon
Z12.12	Encounter for screening for malignant neoplasm of rectum
Z12.13	Encounter for screening for malignant neoplasm of small intestine
Z86.010	Personal history of colonic polyps

CT colonography benefit counting

Policy statementCT colonography (virtual colonoscopy) procedure codes are counted against the member's annual lab and X-ray benefit limit.

Reimbursement limitationCT colonography is not reimbursable when used as an alternative to instrument/fiberoptic colonoscopy for screening in asymptomatic members.

When reimbursableReimbursable only when instrument/fiberoptic colonoscopy of the entire colon is incomplete due to inability to pass the colonoscope and other conditions are met.

Follow-up requirementAny abnormal or suspicious CT colonography findings require subsequent instrument/fiberoptic colonoscopy for diagnosis or treatment.

Provider Authorization, Billing, and Documentation Requirements

Prior Authorization

No prior authorization required for participating providers

Prior authorization is not required for participating providers for colorectal cancer screening and surveillance.

Billing Rule

Submit HCPCS/CPT codes and modifiers; policy does not guarantee reimbursement

Reimbursement is dependent on submission of HCPCS and CPT codes with appropriate modifiers; the policy does not ensure an authorization or reimbursement and services remain subject to member benefits, eligibility, medical necessity, provider contract, and utilization management rules.

Submit applicable HCPCS/CPT codes and appropriate modifiers with claims.
Authorization or reimbursement is not guaranteed; refer to plan Evidence of Coverage and provider contract.

Screening and Surveillance Definitions

Colorectal Cancer Screening (definition)

DefinitionTesting for early-stage colorectal cancer and precancerous lesions in asymptomatic members with an average risk.

Target populationAsymptomatic members at average risk (no personal or significant family history, no inflammatory bowel disease, no hereditary colorectal cancer syndrome).

Examples of covered testsCovered screening modalities include FIT, gFOBT, mt-sDNA, flexible sigmoidoscopy, colonoscopy; CT colonography has limits (see policy).

Surveillance for Colorectal Cancer (definition)

DefinitionClose observation for members who are at increased or high risk for colorectal cancer.

Risk factorsIncludes personal or family history of colorectal cancer or certain polyps, inflammatory bowel disease, prior pelvic/abdominal radiation, or confirmed/suspected hereditary colorectal cancer syndromes (eg, FAP, Lynch syndrome).

Coding requirementSurveillance claims must be submitted with appropriate ICD-10 surveillance/history codes (policy lists applicable codes).