Page 260 - Medicare Benefit Policy Manual

knowledgeable about the beneficiary’s medical condition, and who
would be responsible for using the results of any examination performed
in the overall management of the beneficiary’s specific medical
problem.)
NOTE: For claims with dates of service prior to January 1, 2007,
physicians, suppliers, and providers report HCPCS code G0107.
Effective January 1, 2007, code G0107, is discontinued and replaced
with CPT code 82270. For complete claims processing information refer
to Pub. 100-04, Medicare Claims Processing Manual, chapter 18, section
60.

Effective January 1, 2023, the minimum age for FOBT screening tests is
reduced to 45 years and older. For complete claims processing information,
refer to Pub 100-04, Medicare Claims Processing Manual, chapter 18, section
60.

B. Screening Flexible Sigmoidoscopies (code G0104)

For claims with dates of service on or after January 1, 2002, A/B MACs
(B) 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 at 42 CFR 410.74, 410.75, and 410.76) at
the frequencies noted below. For claims with dates of service prior to
January 1, 2002, pay for these services under the conditions noted only
when they are performed by a doctor of medicine or osteopathy.

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

Once every 48 months (i.e., at least 47 months have passed following the
month in which the last covered screening flexible sigmoidoscopy was
done).

For services furnished on or after July 1, 2001

Once every 48 months as calculated above unless the beneficiary does
not meet the criteria for high risk of developing colorectal cancer (refer
to §280.2.3) and the beneficiary has had a screening colonoscopy (code
G0121) within the preceding 10 years. If such a beneficiary has had a
screening colonoscopy within the preceding 10 years, then he or she can
have covered a screening flexible sigmoidoscopy only after at least 119
months have passed following the month that he/she received the
screening colonoscopy (code G0121).

NOTE: If during the course of a screening flexible sigmoidoscopy a