Colonoscopy: 45378, G0121, G0105: Score Medicare Pay with These FAQs

Why This Topic Matters

Colorectal cancer screening claims are frequently denied or paid differently when eligibility, timing, or coding rules are not met. Understanding the article helps coding and billing staff recognize the high-level factors that affect whether a colonoscopy is treated as a screening or a diagnostic service.

Article Sections

1. Who's Eligible for Average-Risk Test?

   Introduces Medicare screening eligibility for average-risk patients and discusses the general frequency limitations tied to routine colorectal cancer screening.

2. What ICD-9 Codes Are In Play for G0121?

   Covers diagnosis-code support for an average-risk screening claim and mentions additional diagnosis coding considerations.

3. What if the Patient Had a Recent Flexible Sig?

   Addresses how prior colorectal screening history affects later screening eligibility and timing under Medicare.

4. What About Coverage for High-Risk Patients?

   Summarizes Medicare screening eligibility for patients considered at higher risk and discusses the general types of risk factors involved.

5. Can I Bill Private Payers for Screenings?

   Notes that private payer coverage may differ from Medicare and references screening billing practices outside Medicare.

6. What Happens When Screening Turns Diagnostic?

   Describes the general situation in which a screening colonoscopy is converted to a diagnostic service and references related Medicare guidance.