Page 261 - Medicare Benefit Policy Manual

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.

Effective January 1, 2023, the minimum age for Screening Flexible
Sigmoidoscopies 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.

C. Screening Colonoscopies for Beneficiaries at High Risk of
Developing Colorectal Cancer (Code G0105)

The A/B MAC (B) must pay for screening colonoscopies (code G0105)
when performed by a doctor of medicine or osteopathy at a frequency of
once every 24 months for beneficiaries at high risk for developing
colorectal cancer (i.e., at least 23 months have passed following the
month in which the last covered G0105 screening colonoscopy was
performed). Refer to §280.2.3 for the criteria to use in determining
whether or not an individual is at high risk for developing colorectal
cancer.

NOTE: If during the course of the screening colonoscopy, a lesion or
growth is detected which results in a biopsy or removal of the growth,
the appropriate diagnostic procedure classified as a colonoscopy with
biopsy or removal should be billed and paid rather than code G0105.

Effective January 1, 2023, colorectal cancer screening tests include a follow-on
Screening Colonoscopy for Beneficiaries at High Risk of Developing Colorectal
Cancer after a Medicare covered non-invasive stool-based colorectal cancer screening
test returns a positive result. Non-invasive stool-based colorectal cancer screening
tests include:

• Screening Guaiac-based Fecal Occult Blood Test (gFOBT) (82270)
• Screening Immunoassay-based Fecal Occult Blood Test (iFOBT) (G0328)
• Screening The Cologuard™ – Multi-target Stool DNA (sDNA) Test (81528)

The frequency limitations described for Screening Colonoscopies for Beneficiaries at
High Risk of Developing Colorectal Cancer in this section shall not apply in the
instance of a follow-on Screening Colonoscopy for Beneficiaries at High Risk of
Developing Colorectal Cancer after a Medicare covered non-invasive stool-based
colorectal cancer screening test returns a positive result. For complete claims
processing information, refer to Pub 100-04, Medicare Claims Processing Manual,
chapter 18, section 60.

D. Screening Colonoscopies Performed on Individuals Not Meeting