Service is considered colorectal cancer screening services, age limit, every 48 months

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

G0104 - Colorectal Cancer Screening; Flexible Sigmoidoscopy

Screening flexible sigmoidoscopies (code G0104) may be paid for beneficiaries who have attained age 50, when performed by a doctor of medicine or osteopathy at the frequencies noted below.

For claims with dates of service on or after January 1, 2002, contractors or carriers pay for screening flexible sigmoidoscopies (code G0104) for beneficiaries who have attained age 50 when these services were performed by a doctor of medicine or osteopathy, or by a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in §1861(aa) (5) of the Act and in the Code of Federal Regulations at 42 CFR 410.74, 410.75, and 410.76) at the frequencies noted. For claims with dates of service prior to January 1, 2002, contractors pay for these services under the conditions noted only when a doctor of medicine or osteopathy performs them.

For services furnished from January 1, 1998, through June 30, 2001, inclusive:

For services furnished on or after July 1, 2001: :

NOTE: If during the course of a screening flexible sigmoidoscopy a lesion or growth is detected which results in a biopsy or removal of the growth; the appropriate diagnostic procedure classified as a flexible sigmoidoscopy with biopsy or removal should be billed and paid rather than code G0104.
(See CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 60.2)

References:

Service is considered colorectal cancer screening services, age limit, every 48 months. (2015, December 21). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/service-is-considered-colorectal-cancer-screening-services-age-limit-every-48-months-31628.html

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