P2P Call Guide

How to Win a P2P Call for Colonoscopy Denied by MA Plans

Payer-specific strategy, medical necessity arguments, and the exact phrases to use when Medicare Advantage denies Colonoscopy (CPT 45378, 45380, 45385).

Why MA Plans Denies Colonoscopy

Screening interval not met

Prior authorization not obtained

Age does not meet screening criteria

Know Medicare Advantage's Criteria

Medicare Advantage plans must cover all services covered by Original Medicare (CMS NCDs and LCDs) but may require prior auth. Plans use various criteria including InterQual, MCG, and proprietary guidelines.

Key policies to know:

  • Must cover all services covered by Original Medicare
  • Can require prior authorization not required by Original Medicare
  • CMS NCDs and LCDs serve as coverage floor
  • Organization determinations must be issued within 14 days (72 hours for expedited)

Building Your Medical Necessity Argument

Distinguish diagnostic from screening indication

Document symptoms warranting diagnostic colonoscopy

Reference family history or personal risk factors

Note positive screening test (FIT, Cologuard) requiring follow-up

P2P Call Tips for MA Plans

Cite the relevant CMS NCD or LCD -- MA plans cannot deny what Medicare covers

If the service has a CMS NCD, that trumps the MA plan's internal criteria

Reference CMS regulations on MA coverage obligations

Request expedited determination if clinical urgency exists

Guidelines to Reference

  • USPSTF Colorectal Cancer Screening Recommendations
  • AGA Guidelines for Colonoscopy Surveillance
  • NCCN High-Risk Screening Guidelines

Relevant CPT Codes

CPT 45378CPT 45380CPT 45385

Specialty: Gastroenterology

Want the full strategy?

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