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36.4.12 Endoscopies
The following endoscopies are benefits of the Texas Medicaid Program:
• Bronchoscopy.
•Cystourethroscopy.
•Endoscopic retrograde cholangiopancreatography (ERCP).
•Lower gastrointestinal endoscopy (GED) (for example, colonoscopy).
•Upper GED (for example, esophagogastroduodenoscopy [EGD]).
•Sinus endoscopy.
Multiple diagnostic or operative endoscopies in the same or different body areas are often billed on the same day. If done by the same provider, they may be paid the full amount allowed for the major procedure and one-half the allowed amount for each additional procedure, following multiple surgical guidelines.
If the physician bills separate charges for multiple endoscopies that are considered part of a more inclusive procedure, HHSC or its designee reviews the individual charges and pays only the procedure with the more inclusive code.
Example: Separate charges for an esophagoscopy, a gastroscopy, and a duodenoscopy are reviewed and paid as an EGD. A surgical endoscopy always includes the diagnostic endoscopy.
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