Characteristics of High Risk and How Often Test can be Performed

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
December 21st, 2015

According to Medicares Pub-100, 60 - Colorectal Cancer Screening Ref: AB-03-114;

Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month in which the last covered G0105 screening colonoscopy was performed). 

Characteristics of the High Risk Individual:

An individual at high risk for developing colorectal cancer has one or more of the following:

NOTE: If during the course of the screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the growth, the appropriate diagnostic procedure classified as a colonoscopy with biopsy or removal should be billed and paid rather than code G0105.

When a covered colonoscopy is attempted but cannot be completed because of extenuating circumstances, Medicare will pay for the interrupted colonoscopy as long as the coverage conditions are met for the incomplete procedure. (See CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 60.2(A)(1) for additional information.)


Characteristics of High Risk and How Often Test can be Performed. (2015, December 21). Find-A-Code Articles. Retrieved from

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