Summary & Overview

HCPCS G0106: Colorectal Cancer Screening, Imaging Alternative

HCPCS Level II code G0106 denotes a colorectal cancer screening provided as an alternative to G0104, screening sigmoidoscopy, or barium enema. This screening code is nationally relevant because colorectal cancer screening is a preventative service with important implications for population health, early cancer detection, and payer coverage policy. The code is used in ambulatory and outpatient settings where imaging-based colorectal screening alternatives are performed.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for colorectal screening alternatives, common billing and coding considerations, and benchmarking information where available. The publication outlines payer coverage patterns, typical places of service, and administrative notes relevant to facilities and clinicians submitting claims for colorectal cancer screening alternatives.

This summary provides a concise reference for billing staff, revenue cycle teams, and policy analysts seeking a national-level understanding of HCPCS Level II code G0106, including what the code represents, where it is typically billed, and which major payers are included in the coverage discussion. Data not available in the input will be noted in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0106HCPCS Level IIcolorectal screeningsigmoidoscopy alternativeoutpatient screeningpreventive carebillingmedical coding

Billing Code Overview

HCPCS Level II code G0106 represents a colorectal cancer screening procedure described as an alternative to G0104, screening sigmoidoscopy, barium enema. The service type is colorectal cancer screening and the typical site of service is outpatient screening/facility setting or ambulatory surgical centers where colorectal imaging procedures are performed. Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old asymptomatic patient presents to an outpatient ambulatory surgery center for colorectal cancer screening using a screening sigmoidoscopy alternative billed with G0106. The patient has no active gastrointestinal complaints, no recent abdominal pain or bleeding, and meets preventive screening criteria for average-risk colorectal cancer screening. Pre-procedure workflow includes pre-authorization where applicable, history and medication reconciliation, informed consent, bowel preparation review, and nursing assessment. On the day of service, the patient is placed in the left lateral position, monitored by nursing staff, and the procedure is performed by a qualified colorectal surgeon or gastroenterologist. Sedation or analgesia is administered per facility protocol when indicated; recovery and discharge instructions are provided with documentation of findings, specimens (if any), and follow-up recommendations. Typical sites of service include an ambulatory surgery center, outpatient hospital endoscopy suite, or physician office procedure room. Common scenarios include routine prevention for average-risk adults, patient preference for limited lower endoscopic evaluation, or as an alternative when full colonoscopy is not feasible.

Coding Specifications

Modifier	Description	When to Use
`11`	Professional component	Use when reporting the physician’s professional services separately from the technical component.
`26`	Professional component	Alternate representation for professional component when service has distinct technical component billed by facility.
`52`	Reduced services	Use when the procedure was partially reduced or not completed due to clinical reasons but still billed.
`53`	Discontinued procedure	Use when procedure started but was discontinued due to patient condition or safety concerns.
`54`	Surgical care only	Use if the surgeon provides only the operative portion and another provider furnishes pre/post op care.
`55`	Postoperative management only	Use when billing provider only furnishes postoperative care.
`56`	Preoperative management only	Use when billing provider only furnishes preoperative evaluation and management.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure.
`23`	Unusual anesthesia	Use when procedure performed with general anesthesia due to unusual circumstances for a typically non-anesthetized procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician serves as assistant at procedure as permitted by payor.
`TC`	Technical component	Use when billing the facility or entity providing equipment, supplies, and technical support separately.
`22`	Increased procedural services	Use when work required is substantially greater than typical for the procedure (document justification).
`52`	Reduced services	Duplicate entry avoided; included once above.

Taxonomy Code	Specialty	Notes
`207L00000X`	Colon and Rectal Surgery	Primary specialty performing sigmoidoscopy and limited colorectal procedures.
`208000000X`	General Surgery	Surgeons who perform outpatient colorectal screening procedures.
`207RC0000X`	Gastroenterology	Gastroenterologists performing lower endoscopic screening alternatives.
`363L00000X`	Anesthesiology	Provides anesthesia services when sedation or anesthesia is required.
`363A00000X`	Nurse Anesthetist	Provides anesthesia services under supervision in ambulatory settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z12.11`	Encounter for screening for malignant neoplasm of colon	Primary screening indication for colorectal cancer screening procedures.
`Z12.12`	Encounter for screening for malignant neoplasm of rectum	Screening indication when focus includes rectal evaluation.
`K50.90`	Crohn's disease, unspecified, without complications	May be relevant as a comorbidity that affects procedural approach or surveillance intervals.
`K51.90`	Ulcerative colitis, unspecified, without complications	Chronic inflammatory bowel disease requiring tailored surveillance and possible endoscopic evaluation.
`R19.5`	Other fecal abnormalities	Symptom that may prompt limited lower endoscopic evaluation in addition to screening.
`K63.5`	Polyp of colon	Finding that may be identified during screening and require biopsy or removal.
`D12.6`	Benign neoplasm of colon, unspecified	Represents benign lesions that can be detected and managed during sigmoidoscopy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45330`	Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Common full CPT-level equivalent for flexible sigmoidoscopy diagnostic procedures often performed when screening identifies findings.
`45331`	Sigmoidoscopy, flexible; with biopsy, single or multiple	Performed when a lesion is identified during screening and tissue is obtained for pathology.
`45333`	Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps	Used when polypectomy or lesion removal is performed during the procedure.
`45334`	Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique	Used for snare polypectomy of identified polyps during the screening exam.
`99152`	Moderate sedation services provided by the same physician performing the procedure, initial 15 minutes	Billed when moderate sedation is provided by the physician during the sigmoidoscopy procedure.