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When billing a screening colonoscopy for Medicare Advantage HMO or PPO
members, it is important to report code G0105 (for high-risk patients) or code
G0121 (for patients who are not high-risk) to ensure patients receive the
highest level of available benefits. If code G0105 or G0121 is not reported for
screening colonoscopies, it could create significant and unnecessary member
out-of-pocket costs and patient dissatisfaction.
Note: If during the course of the screening colonoscopy, a lesion or
growth is detected and results in a biopsy or removal of the growth, the
appropriate diagnostic CPT® code classified as a colonoscopy
with biopsy or removal should be reported rather than code G0105 or G0121.
Please note that if a screening colonoscopy turns into a diagnostic
colonoscopy, the member is responsible for applicable cost-sharing.
CPT copyright 2014 American Medical Association. All rights
reserved. CPT is a registered trademark of the American Medical
Association.
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