The PRIT is discussing the issue with subject matter experts and has suggested several possible resolutions with the college. Dec 17:Medicare coverage is permitted for services which are "reasonable and necessary for the diagnosis or treatment of illness or injury" by law (Title 18 of the Social Security Act 1862(a)(1)(A)) and therefore a precolonoscopy E&M which meets this requirement will normally be covered. An E&M visit which does not meet this reasonable and necessary standard is defined as noncovered by the law. Only congress can allow exceptions to this reasonable and necessary standard by creating a special benefit category as it has for each of the preventative benefits now covered by Medicare.
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