Summary & Overview
HCPCS G0102: Prostate Cancer Screening, Digital Rectal Examination
HCPCS Level II code G0102 denotes a prostate cancer screening performed by digital rectal examination. This screening code represents a preventive clinical service used to identify potential prostate abnormalities that may warrant further diagnostic evaluation. As a nationally relevant preventive procedure, this code intersects with primary care and urology practice patterns and preventive care coverage policies across major payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage considerations, common billing modifiers (listed separately), and the clinical context for use of the code. The publication outlines how G0102 is used in outpatient and physician office settings for routine prostate cancer screening and highlights typical documentation elements and encounter settings.
The report provides benchmarks and policy-related summaries to inform billing and administrative teams about coding expectations and where to seek payer-specific guidance. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G0102 describes prostate cancer screening performed via digital rectal examination. The service is a screening procedure intended to detect signs of prostate cancer through a physical examination of the prostate gland.
Service Type: Prostate cancer screening — digital rectal examination
Typical Site of Service: Outpatient clinic or physician office, including primary care and urology offices where routine cancer screening examinations are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is a man aged 50–75 presenting to a primary care clinic or urology practice for routine prostate cancer screening or evaluation of lower urinary tract symptoms. The clinician performs a focused history (family history of prostate cancer, urinary symptoms, prior PSA results) and obtains consent for a physical examination. The service performed is a digital rectal examination (G0102) to assess prostate size, nodularity, asymmetry, or focal induration.
The clinical workflow: the patient is escorted to an exam room, vitals are taken, and the clinician documents indication for screening or diagnostic evaluation. The clinician performs hand hygiene and dons gloves, positions the patient (standing or lateral decubitus), and performs the G0102 exam, documenting findings (normal, enlarged, nodular, tender). If an abnormality is found, the clinician documents recommended next steps such as serum prostate-specific antigen testing, referral to urology, or transrectal ultrasound/biopsy planning. The visit note includes medical necessity, informed consent for the exam, and linkage of the exam to an appropriate ICD-10 diagnosis code in the problem list or encounter diagnosis.
Typical site of service: outpatient clinic, physician office, or ambulatory care setting. The service is commonly performed by primary care physicians and urologists and may be billed as a preventive screening exam when appropriate documentation supports a screening encounter or as diagnostic when symptoms or abnormal findings are present.
Coding Specifications
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