G2204 Screening Colonoscopy HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS G2204: Screening Colonoscopy for Patients Aged 45–85

HCPCS Level II code G2204 denotes patients aged 45 to 85 who received a screening colonoscopy during the performance period. As a preventive measure tied to colorectal cancer screening quality reporting and performance measurement, this code is nationally relevant for payers, quality programs, and health systems tracking screening rates in guideline-recommended age groups. It facilitates standardized reporting of screening colonoscopy delivery and supports population-level monitoring of preventive care.

Key payers included in related analyses are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on clinical intent (screening colonoscopy for ages 45–85), typical sites of service (facility-based endoscopy suites and hospital outpatient departments), and how the code is used in performance measurement. The publication also outlines benchmarking approaches, common modifiers and administrative considerations, and the clinical context for screening in the specified age range.

Data limitations: Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes. Specific payer policies and reimbursement details vary by plan and are not provided here.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG2204HCPCS Level IIscreening colonoscopycolorectal cancer screeningpreventive carequality measurementendoscopyhospital outpatientage 45-85

Billing Code Overview

HCPCS Level II code G2204 identifies patients between 45 and 85 years of age who received a screening colonoscopy during the performance period. This code represents a measure of preventive colorectal cancer screening captured for the specified age cohort.

Service type: Screening colonoscopy
Typical site of service: Facility-based endoscopy suite or hospital outpatient department

Clinical & Coding Specifications

Clinical Context

A 58-year-old average-risk patient presents for a screening colonoscopy during an outpatient endoscopy session. The patient has no active gastrointestinal symptoms, no prior history of colorectal cancer or inflammatory bowel disease, and is due for routine colorectal cancer screening based on age. Pre-procedure evaluation includes confirmation of informed consent, medication reconciliation (including anticoagulant management), and bowel preparation adequacy. On the day of service, the patient arrives to the endoscopy suite, is assessed by nursing and the gastroenterology team, receives moderate sedation (or monitored anesthesia care if indicated), undergoes complete colonoscopic visualization to the cecum with documentation of bowel prep quality, and any polyps identified are removed and sent to pathology. Post-procedure recovery is monitored in the PACU until discharge criteria are met. Typical sites of service are the ambulatory surgery center or hospital outpatient endoscopy unit. The service described by G2204 specifically captures patients aged 45–85 who received a screening colonoscopy during the performance period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to perform the colonoscopy is substantially greater than typically required (e.g., extensive adhesiolysis or difficult anatomy) and supported by documentation.

Related Codes

HCPCS-G9675-LDL-C-190-MGDL-HISTORY

HCPCS G9675: History of LDL-C 190 mg/dL

HCPCS-G9932-TB-SCREENING-DOCUMENTATION-NO-RECORDS

HCPCS G9932: Documentation of Missing TB Screening Records

HCPCS-G9781-DOCUMENTATION-STATIN-THERAPY-NONUSE

HCPCS G9781: Documentation of Medical Reasons for Statin Nonuse

HCPCS-G0144-CERVICAL-VAGINAL-CYTOLOGY-AUTOMATED-THIN-LAYER-SCREENING

HCPCS G0144: Cervical or Vaginal Cytopathology Screening, Automated

HCPCS-G0917-PATIENT-CARE-SURVEY-NOT-COMPLETED

HCPCS G0917: Patient Care Survey Not Completed by Patient

HCPCS-G0503-PSYCHIATRIC-COLLABORATIVE-CARE-MANAGEMENT-SUBSEQUENT-60-MIN

HCPCS G0503: Subsequent Psychiatric Collaborative Care Management, First 60 Minutes

HCPCS-G8577-CARDIAC-RE-EXPLORATION-FOR-MEDIATORNAL-BLEEDING-UNPLANNED-INTERVENTION

HCPCS G8577: Cardiac Re-exploration for Postoperative Complications

HCPCS-G9805-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS G9805: Hospice Services During Measurement Period

HCPCS-G8843-NON-MEASUREMENT-AHI-RDI-REI-DOCUMENTATION

HCPCS G8843: Documentation for Not Measuring AHI/RDI/REI

HCPCS-G9730-PATIENT-REFUSED-TO-PARTICIPATE

HCPCS Level II G9730: Patient Refused to Participate

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RH0000X`	Gastroenterology	Gastroenterologists most commonly perform screening colonoscopy.
`208000000X`	General Surgery	General surgeons perform colonoscopy in operative or complex cases.
`344600000X`	Anesthesiology	Anesthesiologists provide monitored anesthesia care or general anesthesia for select colonoscopies.
`367500000X`	Nurse Anesthetist	Certified registered nurse anesthetists commonly provide anesthesia services for endoscopy.
`363A00000X`	Physician Assistant	Physician assistants often assist in peri-procedural care in endoscopy units.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z12.11`	Encounter for screening for malignant neoplasm of colon	Primary screening indication for average-risk colonoscopy in adults.
`Z80.0`	Family history of malignant neoplasm of digestive organs	Documented family history may alter screening interval or method.
`K57.30`	Diverticulosis of large intestine without perforation or abscess without bleeding	Common incidental finding relevant to colonoscopy planning and interpretation.
`K21.9`	Gastro-esophageal reflux disease without esophagitis	Common comorbidity; not an indication for screening colonoscopy but may be present in patient history.
`R19.4`	Change in bowel habit	Symptom that, if present, could change the procedure from screening to diagnostic colonoscopy and affect coding.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45378`	Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Core diagnostic colonoscopy code commonly used for screening colonoscopy when no polypectomy is performed.
`45380`	Colonoscopy with biopsy, single or multiple	Used when mucosal biopsies are taken during the screening colonoscopy for diagnostic evaluation.
`45385`	Colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) by snare technique	Used when polypectomy is performed during the screening colonoscopy using snare technique.
`45384`	Colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery	Alternative CPT for certain polypectomy techniques performed during the procedure.
`00810`	Anesthesia for intrathoracic procedures, not otherwise specified; general anesthesia (example anesthesia base code) — note: anesthesia CPTs vary by service unit and complexity	Represents anesthesia services that may be billed when monitored anesthesia care or general anesthesia is provided for colonoscopy.