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Medical billing and Medical coding

Dr Zheng follows all billing and coding guidelines. She will always use "preventive codes" when indicated. ie Modifier 33 (Procedural Terminology (CPT) code that identifies preventive services).

ICD code starts with "Z", such as Z12.11 (ICD 10 code for Encounter for screening for malignant neoplasm of colon, average risk).

It's, however, up to insurance to determine your coverage and your out of pocket cost, including copay, coinsurance, deductibles etc.  Even with the same "preventive code", coverage varies depending on insurance, and your out of pocket cost will be different depending on your insurance coverage.  Please contact your insurance carrier directly.

Sphere on Spiral Stairs

Medical bills for a colonoscopy (or endoscopy):

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In addition to professional fees to Gastroenterologist (Dr Zheng), it also  includes facility fees, anesthesia fee, pathology fees and other costs. The total cost depends on several factors, including the type of facility, insurance coverage, and whether the procedure is diagnostic or screening. 

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Gastroenterologist Professions fees 

  • Professions fees for colonoscopy

  • In person or virtual appointment before and after colonoscopy

  • You may have to pay copay, co-insurance and deductibles 

Facility fees 

  • Hospitals typically charge more for facility fees than ambulatory surgical centers (ASC)

  • Most procedures will be done at ASCs. Please contact ASC directly for coverage and cost estimate.

  • You may have to pay co-insurance and deductibles 

Anesthesia fees

  • MAC Anesthesia commonly uses the drug Propofol and is administered via an IV. This type of anesthesia gives comfort to patients and also gives the advantage of a much quicker recovery than conscious sedation

  • You may have to pay co-insurance and deductibles 

Pathology fees 

  • All biopsies and polyps will be submitted to pathology exam

  • You may have to pay co-insurance and deductibles .  Please contact pathology department directly for coverage and cost estimate

 

Other costs

Medical transportation cost

  • You will need to arrange for someone to take you home after the colonoscopy.  It can take awhile for the sedative to wear off, so it is not considered safe for you to drive, take public transportation on your own, go back to work, or make important decisions that day

  • If you don't have family or friend pick up after procedure, please arrange medical transportation

Prescriptions

  • Bowel preparation before procedure

  • Painkillers and other medication (if needed) post procedure

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Coverage, Cost estimate and Questions

  • You should check with your insurance carrier to learn more about any costs associated with your colonoscopy, EGD (upper endoscopy) and other GI procedures

  • You can contact our independent billing team if you have more questions. (see below) 

Insurance

We accept most major insurance companies, such as (not limited to):

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  • AARP

  • Aetna

  • Affinity/Stanford

  • Brown and Toland

  • Blue Cross

  • Blue Shield

  • CCHP

  • Cigna

  • Health Net

  • Hills Physician

  • John Muir Health Network (HMO)

  • Medicare

  • Prime Health

  • Tricare

  • United Health Care

  • Etc

We accept most HMO and PPO insurance plans.

We accept Medicare 

We also accept CCHP (Contra Costa Health Plan)

Medical form with stethoscope

If you do not see your insurance company listed, please contact our office at 925-384-9276 for more information.

Questions regarding your medical charge or bill?

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Dr. Zheng’s office uses a separate medical billing service.  The best way to get billing related questions answered is to contact them directly @ Zen Medical Services   Phone (408)372-1691  email: DrZheng@Zenservices.net

Common CPT codes @ Medical office

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In person and virtual office visits​

  • 99205: Initial visit, high severity

  • 99215: Established patient office visit with high complexity 

  • 99204: Initial visit, moderate severity

  • 99214: Established patient office visit with moderate complexity

  • 99203: Initial visit, low to moderate severity

  • 99213: Established patient office visit, low to moderate severity,

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Office based procedures​

  • 91110: Wireless capsule endoscopy of the small bowel

  • 76981: Ultrasound, elastography; parenchyma â€‹â€‹â€‹â€‹

Virtual visit

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Most commercial insurances,  CCHP, Medicare  cover virtual visits, also known as telehealth appointments. You can use your phone or computer to have a virtual visit.​

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After October 1, 2025, Medicare virtual visits will likely be significantly restricted for most patients, meaning they will generally need to be located in a rural area or at a medical facility to access telehealth services unless Congress takes action to extend current flexibilities; this means most at-home telehealth visits will not be covered under Medicare without further legislative changes. 

Key points about Medicare virtual visits post-October 2025:

  • Limited to rural areas:

    Most telehealth services will likely only be covered if the patient is located in a rural health professional shortage area. 

  • Pre-pandemic restrictions return:

    Medicare will likely revert back to its pre-pandemic telehealth policies, including restrictions on which services can be provided virtually and where patients must be located. 

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Medicare Chronic Care Management (CCM) is a program that helps Medicare beneficiaries with multiple chronic conditions receive coordinated care and support between face-to-face visits, aiming to improve health outcomes and quality of life.  CCM continues to allow virtual visits with providers.

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How to confirm coverage

You can contact your plan provider to confirm coverage and what out-of-pocket expenses to expect. 

Common CPT codes @ ASC

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Colonoscopy codes

  • 45378: Flexible colonoscopy 

  • 45380: Flexible colonoscopy with biopsy

  • 45381: Flexible colonoscopy with submucosal injection

  • 45382: Flexible colonoscopy with bleeding control

  • 45384: Flexible colonoscopy with lesion removal by hot forceps technique

  • 45385: Flexible colonoscopy with lesion removal by snare technique

  • 45388: Flexible colonoscopy with lesion ablation

  • 45389: Flexible colonoscopy with stent placement

  • 45390: Flexible colonoscopy with lesion removal by EMR technique

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Medicare ONLY CPT codes ​

  • G0105: Flexible colonoscopy for high risk screening

  • G0121: Flexible colonoscopy for average risk screening

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Common CPT codes for other GI procedures @ ASC

  • 43235: EGD (upper endoscopy)

  • 43239: EGD (upper endoscopy) with biopsy

  • 43244: esophagogastroduodenoscopy (EGD) with band ligation

  • 43245: esophagogastroduodenoscopy (EGD) with foreign body removal

  • 43249: EGD (upper endoscopy) with balloon dilation

  • 43251  EGD with lesion removal by snare technique​

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  • 44360: Small bowel enteroscopy

  • 44361: Small bowel enteroscopy with biopsy

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  • 46221: Hemorrhoid banding

  • 45330: Flexible sigmoidoscopy 

  • 455331 Flexible sigmoidoscopy  with biopsy

How to pay your medical Bill

How to pay your medical bill​

  • Our EMR Tebra's payment terminal offers a secure, encrypted option for in-person or online payments, and lets patients pay with Credit card, Apple Pay, Google Pay, and touchless pay.

  • You can also send our payment via traditional check

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What if you can't pay your bill on time​

  • Apply for financial difficulty assistance

  • Ask if the provider will forgive part or all of the bill 

  • Ask if the provider will accept a payment plan 

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Phone

(408)372-1691  

 

email: DrZheng@Zenservices.net

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Zen Medical Billing

OUR billing TEAM

We outsource billing so that Dr Zheng can focus her time and energy on excellent patient care

Zen Medical Billing

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Questions regarding your medical charge or bill?

​

Dr. Zheng’s office uses a separate medical billing service.  The best way to get billing related questions answered is to contact them directly @ Zen Medical Services   Phone (408)372-1691  

email: DrZheng@Zenservices.net

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