Summary & Overview
HCPCS G0104: Colorectal Cancer Screening, Flexible Sigmoidoscopy
HCPCS Level II code G0104 designates colorectal cancer screening via flexible sigmoidoscopy, a preventive endoscopic procedure that inspects the distal colon and rectum. Nationally, this screening option plays a role in cancer detection strategies, screening program coverage, and preventive service metrics.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage considerations across major payers, clinical context for when flexible sigmoidoscopy is used, and typical sites where the service is delivered. The publication summarizes common billing considerations, payer policies affecting screening access, and how this screening modality fits into broader colorectal cancer detection efforts.
The content provides benchmarking context, policy updates relevant to preventive services, and practical guidance on coding and service classification for administrators and billing staff. Data not provided in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code G0104 covers colorectal cancer screening performed by flexible sigmoidoscopy. This service is a diagnostic and preventive endoscopic procedure that inspects the distal colon and rectum to detect precancerous lesions and early-stage cancers.
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Service type: Flexible sigmoidoscopy
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in physician office settings when equipped for endoscopy
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Clinical & Coding Specifications
Clinical Context
A 58-year-old average-risk adult presents to an outpatient endoscopy suite for colorectal cancer screening by flexible sigmoidoscopy. The patient completed bowel preparation per instructions and has no active gastrointestinal bleeding, known colorectal cancer, or inflammatory bowel disease. In the pre-procedure area, the nurse verifies informed consent, reviews allergies and current medications, documents comorbid conditions, and applies standard monitoring. The gastroenterologist or colorectal surgeon performs a diagnostic and screening flexible sigmoidoscopy to visualize the rectum and sigmoid colon, obtain biopsies if indicated, and perform limited polypectomy when appropriate under conscious sedation or monitored anesthesia care. Procedure documentation includes indication, extent of exam (distance inserted), findings, interventions (biopsy, polypectomy), specimen labeling, estimated blood loss if any, complications, anesthesia type, and post-procedure disposition. Billing uses G0104 for screening flexible sigmoidoscopy; if a significant unrelated service or diagnostic indication is present, appropriate modifier(s) are appended per payer rules.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified claim | Use when no modifier applies and the service is reported without adjustments |