"VIRTUAL" STUDIES

Thanks to the television and news media, "virtual" colonoscopy and other "virtual" studies have created a great public awareness of these procedures. During recent medical review, it has come to the attention of the Fiscal Intermediary that providers are billing services to the Medicare Program under the subtitle "Virtual Colonoscopy." Please be advised that while the Balanced Budget Act of 1997 allows limited coverage for colorectal cancer screening, there is no program benefit for "Virtual Colonoscopies." There are no "virtual" procedures that have been assigned a CPT/HCPCS code. The studies being billed do not meet the definition of colonoscopy, which is an invasive diagnostic/therapeutic test.

"Virtual" studies performed as a screening tool are not covered, and will be subject to Medical Review suspension and adjudication. Providers performing these services should review the Balanced Budget Act limitations on colorectal screening. Services performed without obtaining the appropriate notice of non-coverage (ABN) will result in provider liability. Services such as CT scans billed as "virtual" studies will be subject to Medical Review.

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER/SUPPLIER STAFF.  BULLETINS ISSUED AFTER OCTOBER 1,1999 ARE AVAILABLE AT NO-COST FROM OUR WEBSITE AT http://www.marylandmedicare.com/.