Medicare Benefits Schedule - Item 32230

Endoscopic mucosal resection using electrocautery of a non‑invasive sessile or flat superficial colorectal neoplasm which is at least 25mm in diameter, if the service is supported by photographic evidence to confirm the size of the polyp in situ

Applicable once per polyp (H) 

Multiple Operation Rule

(Anaes.)

Fee: $761.20 Benefit: 75% = $570.90

(See para TN.8.293 of explanatory notes to this Category)

• Previous - Item 32229
• Next - Item 32231

Endoscopic mucosal resection (EMR) item 32230 is inclusive of the colonoscopy service described in items 32222, 32223, 32224, 32225, 32226 and 32228.

There is a same day, same provider, same patient restriction with claiming any of the colonoscopy items 32222, 32223, 32224, 32225, 32226 and 32228 with item 32230.

Scenario 1

Should identification of a polyp >= 25 mm occur at time of colonoscopy and the provider is sufficiently skilled and the location of the procedure (facility) appropriately resourced, the polyp may be removed (resected) in situ at time of initial colonoscopy provided adequate consent was obtained by the endoscopist before the procedure.

Where this is the case, the provider will no longer bill a colonoscopy item 32222, 32223, 32224, 32225, 32226 or 32228, rather they will bill item 32230.

Scenario 2

Where the provider is unable to remove the polyp/s >=25 mm, and the patient is required to return to have the polyp removed, then the initial procedure identifying the polyp and thus the need for EMR would be billed to either 32222, 32223, 32224, 32225, 32226 or 32228 and the subsequent resection procedure to 32230.

Related Items: 32222 32223 32224 32225 32226 32228 32229 32230