Page 259 - Medicare Benefit Policy Manual

G0104 - Colorectal cancer screening; flexible sigmoidoscopy;

G0105 - Colorectal cancer screening; colonoscopy on individual at high risk;

G0106 - Colorectal cancer screening barium enema; alternative to GO104,
screening sigmoidoscopy;

G0120 - Colorectal cancer screening barium enema; alternative to GO105,
screening sigmoidoscopy.

B. Effective for Services Furnished On or After July 1, 2001:

G0121 - Colorectal Cancer Screening; Colonoscopy on Individual Not Meeting
Criteria for High Risk

C. Effective for Services Furnished On or After January 1, 2004:

G0328 - Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3
simultaneous determinations.

280.2.2 - Coverage Criteria
(Rev. 11865; Issued:02-16-23; Effective: 01-01-23; Implementation:02-27-23)

The following are the coverage criteria for these screenings:

A. Screening Fecal-Occult Blood Tests (FOBT) (Codes 82270 & G0328)

Effective for services furnished on or after January 1, 2004, one
screening FOBT (code 82270 or G0328) is covered for beneficiaries who
have attained age 50, at a frequency of once every 12 months (i.e., at
least 11 months have passed following the month in which the last
covered screening FOBT was done). Screening FOBT means: (1) a
guaiac-based test for peroxidase activity in which the beneficiary
completes it by taking samples from two different sites of three
consecutive stools or, (2) an immunoassay (or immunochemical) test for
antibody activity in which the beneficiary completes the test by taking
the appropriate number of samples according to the specific
manufacturer’s instructions. This expanded coverage is in accordance
with revised regulations at 42 CFR 410.37(a)(2) that includes “ other
tests determined by the Secretary through a national coverage
determination.” This screening requires a written order from the
beneficiary’s attending physician or for claims with dates of service on or
after January 27, 2014, from the beneficiary’s attending physician
assistant, nurse practitioner, or clinical nurse specialist. (The term
“attending physician” is defined to mean a doctor of medicine or
osteopathy (as defined in §1861(r)(1) of the Act) who is fully