Pursuant to W.S. 35-25-204, the WCCEDP will reimburse providers for the costs relating to colonoscopy screening only.
(a) Services covered by the WCCEDP. Expenses that may be reimbursed by the WCCEDP at the rate paid under the Wyoming Medical Assistance and Services Act are as follows: - (i) Pre-operative consultation fee;
- (ii) Colonoscopy: Flexible, proximal to splenic flexure; diagnostic with or without collection or specimens;
- (iii) Colonoscopy with single or multiple cold biopsy;
- (iv) Colonoscopy with directed submucosal injection(s) of any substance;
- (v) Colonoscopy with control of bleeding;
- (vi) Colonoscopy with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery, or snare technique;
- (vii) Colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery;
- (viii) Colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) by snare technique;
- (ix) Level IV surgical pathology, gross and microscopic examination; and
- (x) Facility and anesthesiology fees as listed on the WCCEDP-approved CPT code list.
(b) Services not covered by the WCCEDP. - (i) There will be no reimbursement to providers for colonoscopies or related costs performed prior to the WCCEDP Enrollment Start-Date. The applicant/patient must have a WCCEDP payment voucher to present to the provider prior to the procedure. If applicant/patient does not have proper enrollment approval, the applicant/patient will assume responsibility for any costs relating to procedures performed prior to enrollment approval.
- (ii) Other screenings, such as Standard or Immunochemical Fecal Occult Blood Testing (FOBT), Flexible Sigmoidoscopy, Barium Enema, Stool Mutational Analysis, CT and MRI Colonography (Virtual Colonoscopy), Screening tests requested at intervals sooner than are recommended by program guidelines (unless the Department provides a written waiver to applicant pursuant to a written explanation letter by the attending physician), Medical therapy for Inflammatory Bowel Disease, or Genetic Testing are not reimbursable by the WCCEDP.
- (iii) Reimbursement for Adverse Events is not covered by the WCCEDP. The program will only reimburse for procedures identified in the WCCEDP approved-CPT coding list.
- (iv) The WCCEDP shall not reimburse for follow up surgery or additional care needed if an actual cancer or other condition requiring additional care is found.
048-17 Wyo. Code R. § 17-3