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.

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