Results 1 to 2 of 2

HCPCS Codes for Screening Colonoscopies

  1. Default HCPCS Codes for Screening Colonoscopies
    Medical Coding Books
    Hello All,

    I was recently reviewing an old Coding Edge "Test Yourself" (like I don't have anything else to do) and was unable to locate the desired information to answer a question in that issue. Are there "oops" questions included that are errors on the publisher side or put in as a "trick" to see if we are paying attention?

    Thanks for your insight!

    Cathy Klein, LPN, CPC, UMT
    Indianapolis IN Chapter

  2. #2
    Default Medicare Billing Rules for Screening Colonoscopies
    I am a Medicare A/R specialist for a large Gastro. group in Washington. I hope the following information helps!

    · Screening flexible sigmoidoscopy: Medicare covers a screening flexible sigmoidoscopy once every 4 years for beneficiaries 50 and older. If a beneficiary had a screening colonoscopy in the previous 10 years, then the next screening flexible sigmoidoscopy would be covered only after 119 months have passed following the month in which the last screening colonoscopy was performed. A doctor of medicine or osteopathy, a physician assistant, a nurse practitioner, or a clinical nurse specialist may perform a screening flexible sigmoidoscopy.

    · Screening colonoscopy: Medicare coverage for a screening colonoscopy is based on beneficiary risk. For beneficiaries 50 and older not considered to be at high risk for developing colorectal cancer, Medicare covers 1 screening colonoscopy every 10 years, but not within 47 months of a previous screening flexible sigmoidoscopy. For beneficiaries considered to be at high risk for developing colorectal cancer, Medicare covers 1 screening colonoscopy every 2 years, regardless of age. A screening colonoscopy must be performed by a doctor of medicine or osteopathy.

    How to Bill Medicare

    The following Healthcare Common Procedure Coding System/Current Procedure Terminology (HCPCS/CPT) codes should be used to bill for colorectal cancer screening services:


    CPT Code
    Code Descriptors

    Colon cancer screening; flexible sigmoidoscopy

    Colon cancer screening; colonoscopy on individual at high risk

    Colon cancer screening; barium enema as an alternative to G0104

    Colon cancer screening; FOBT, patient was provided 3 single cards or single triple card for consecutive collection

    Colon cancer screening; barium enema as an alternative to G0105

    Colon cancer screening; colonoscopy for individuals not meeting criteria for high risk

    Colon cancer screening; barium enema (non-covered)

    Colon cancer screening; fecal occult blood test, immunoassay

    * When billing for the "high risk" beneficiary, the screening diagnosis code on the claim must reflect at least one of the high risk conditions mentioned previously. Examples of diagnostic codes are in the colorectal cancer screening chapter of the Guide to Preventive Services. This guide is available on the CMS website at:

    **Medicare covers colorectal barium enemas only in lieu of covered screening flexible sigmoidoscopies (G0104) or covered screening colonoscopies (G0105). However, there may be instances when the beneficiary has elected to receive the barium enema for colorectal cancer screening other than specifically for these purposes. In such situations, the beneficiary may require a formal denial of the service from Medicare in order to bill a supplemental insurer who may cover the service. These non-covered barium enemas are to be identified by G0122 (colorectal cancer screening; barium enema). Code G0122 should not be used for covered barium enema services, that is, those rendered in place of the covered screening colonoscopy or covered flexible sigmoidoscopy. The beneficiary is liable for payment of the non-covered barium enema.

    If billing Carriers, the appropriate HCPCS and corresponding diagnosis codes must be provided on Form CMS-1500 (or the HIPAA 837 Professional electronic claim record).

    If billing Intermediaries, the appropriate HCPCS, revenue, and corresponding diagnosis codes must be provided on Form CMS-1450 (or the HIPAA Institutional electronic claim record). Information on the type of bill and associated revenue code is also provided in the colorectal cancer screening chapter of the Guide to Preventive Services. Once again, this guide is available a on the CMS website t: Reimbursement information is also provided in this guide.

    I hope this was helpful!!

    Sunni Hearin

Similar Threads

  1. Screening colonoscopies
    By cynthiabrown in forum Gastroenterology
    Replies: 3
    Last Post: 08-15-2014, 09:43 AM
  2. Counseling/Screening Using HCPCs codes
    By in forum Behavioral Health
    Replies: 0
    Last Post: 10-21-2013, 05:43 AM
  3. Screening colonoscopies please help!
    By Tracy592 in forum Gastroenterology
    Replies: 2
    Last Post: 09-11-2012, 01:30 PM
  4. Screening colonoscopies
    By Colliemom in forum Gastroenterology
    Replies: 6
    Last Post: 01-03-2011, 09:36 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.