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$0 follow-up colonoscopies for commercial members

PacificSource will pay for colonoscopies, performed under the guidance stated below, at 100%. This change will occur across the board effective June 1, 2022, for all fully insured business and upon renewal for self-funded business.

About the guidance

The United States Preventive Services Task Force (USPSTF) updated its recommendation for colorectal cancer screenings which states that the follow-up colonoscopy is an integral part of the preventive screening, otherwise the screening would not be considered complete. USPSTF has therefore recommended that the follow-up colonoscopy after a positive noninvasive, stool-based screening test or direct visualization screening test is required to be covered without cost-sharing in accordance with the requirements of PHS Act section 2713.

CMS FAQ part 51 and IRS notice 2013-57 offer guidance clarifying that a health plan must qualify as a high-deductible health plan (HDHP) if it provides, without a deductible, the preventive health services required under section 2713 of the Public Health Service Act (PHS Act).

This guidance takes effect for plan or policy years beginning on or after May 31, 2022.