Thursday, September 8, 2011

CPT code G0104 - G0121 - Colorectal Cancer Screening

Colorectal  Cancer Screening CPT CODES 

G0104 – Flexible Sigmoidoscopy
 G0105 – Colonoscopy (high risk)
G0106 – Barium Enema (alternative to G0104)
G0120 – Barium Enema (alternative to G0105)
G0121 – Colonoscopy (not high risk) G0122 – Barium Enema (non-covered) G0328 – Fecal Occult Blood Test (FOBT) (alternative to 82270)
82270 – FOBT

Use appropriate diagnosis code Contact the local Medicare Contractor for guidance

All Medicare beneficiaries aged 50 and older who are:
At normal risk of developing colorectal cancer; or
At high risk of developing colorectal cancer.*
* High risk for developing colorectal cancer is defined in 42 CFR 410.37(a)(1). See http:// www.gpo.gov/fdsys/pkg/CFR-2010-title42- vol2/pdf/CFR-2010-title42-vol2-sec410-37.pdf on the Internet.


Normal risk:
Fecal Occult Blood Test (FOBT) every year;
Flexible Sigmoidoscopy once every 4 years (unless a screening colonoscopy has been performed and then 


Medicare may cover a screening flexible sigmoidoscopy only after at least 119 months);
Screening Colonoscopy every 10 years (unless a screening flexible sigmoidoscopy has been performed and then Medicare may cover a screening colonoscopy only after at least 47 months); and
Barium Enema (as an alternative to a covered screening flexible sigmoidoscopy).


High risk:
FOBT every year;
Flexible Sigmoidoscopy once every 4 years;
Screening Colonoscopy every 2 years (unless a screening flexible sigmoidoscopy has been performed and then Medicare may cover a screening colonoscopy only after at least 47 months); and
Barium Enema (as an alternative to a covered screening colonoscopy).


Medicare payment 

82270 prior to 01/01/11:
Copayment/coinsurance waived
Deductible waived
All other codes prior to 01/01/11:
Copayment/coinsurance applies
Deductible waived
82270, G0104, G0105, G0121, and G0328 on or after 01/01/11:
Copayment/coinsurance waived
Deductible waived
All other codes on or after 01/01/11:
Copayment/coinsurance applies
Deductible waived

No deductible for all surgical procedures (CPT code range of 10000 to 69999) furnished on the same date and in the same encounter as a colonoscopy, flexible sigmoidoscopy, or barium enema that were initiated as colorectal cancer screening services. Modifier -PT should be appended to at least one CPT code in the surgical range of 10000 to 69999 on a claim for services furnished in this scenario.

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