Summary & Overview
HCPCS G0105: Colorectal Cancer Screening Colonoscopy
HCPCS Level II code G0105 denotes colorectal cancer screening via colonoscopy for individuals identified as high risk. This code is used to document and bill for colonoscopic procedures performed specifically for cancer screening in patients with elevated risk factors. Nationally, accurate use of G0105 matters for preventive care tracking, quality measurement, and appropriate coverage determinations for high-risk populations.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how G0105 is defined, typical sites of service, and the clinical context for use. The publication summarizes common payer considerations and coding practice themes, highlights relevant benchmarks and payment policy updates where available, and clarifies distinctions between screening and diagnostic colonoscopy coding. The content is designed for coding professionals, practice managers, and policy analysts seeking operational and policy context for colorectal cancer screening in high-risk patients.
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Billing Code Overview
HCPCS Level II code G0105 represents colorectal cancer screening performed as a colonoscopy for an individual at high risk. This service is a diagnostic and preventive procedure intended to detect colorectal neoplasia in patients identified as having elevated risk factors.
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Service type: Colonoscopy (screening for high-risk individual)
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Typical site of service: Hospital outpatient department or ambulatory surgical center, where endoscopic procedures are performed.
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Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with a documented family history of colorectal cancer in a first-degree relative presents for preventive screening. The patient is asymptomatic but meets criteria for high-risk colorectal cancer screening due to family history and is scheduled for a screening colonoscopy under moderate sedation. Pre-procedure workflow includes bowel preparation instruction, informed consent, medication reconciliation, and pre-anesthesia assessment. On the day of service, the gastrointestinal specialist documents the indication as high risk, performs a diagnostic and therapeutic colonoscopy with inspection of the colon to the cecum, and removes a suspicious polyp using snare polypectomy. Specimens are submitted to pathology. Post-procedure, the patient is recovered in the ambulatory surgery unit, given discharge instructions emphasizing follow-up and pathology results, and the encounter is coded for colorectal cancer screening in a high-risk individual using billing code G0105 with appropriate modifiers to indicate professional component and any extraordinary circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician's professional interpretation/management for facility-performed colonoscopy. |