Page 263 - Medicare Benefit Policy Manual

E. Screening Barium Enema Examinations (codes G0106 and G0120)

Screening barium enema examinations are covered as an alternative to
either a screening sigmoidoscopy (code G0104) or a screening
colonoscopy (code G0105) examination.
The same frequency parameters for screening sigmoidoscopies and
screening colonoscopies above apply.

In the case of an individual aged 50 or over, payment may be made for a
screening barium enema examination (code G0106) performed after at
least 47 months have passed following the month in which the last
screening barium enema or screening flexible sigmoidoscopy was
performed. For example, the beneficiary received a screening barium
enema examination as an alternative to a screening flexible
sigmoidoscopy in January 1999. The count starts beginning February
1999. The beneficiary is eligible for another screening barium enema in
January 2003.

In the case of an individual who is at high risk for colorectal cancer,
payment may be made for a screening barium enema examination (code
G0120) performed after at least 23 months have passed following the
month in which the last screening barium enema or the last screening
colonoscopy was performed. For example, a beneficiary at high risk for
developing colorectal cancer received a screening barium enema
examination (code G0120) as an alternative to a screening colonoscopy
(code G0105) in January 2000. The count starts beginning February
2000. The beneficiary is eligible for another screening barium enema
examination (code G0120) in January 2002.

The screening barium enema must be ordered in writing after a
determination that the test is the appropriate screening test. Generally, it
is expected that this will be a screening double contrast enema unless the
individual is unable to withstand such an exam. This means that in the
case of a particular individual, the attending physician must determine
that the estimated screening potential for the barium enema is equal to or
greater than the screening potential that has been estimated for a
screening flexible sigmoidoscopy, or for a screening colonoscopy, as
appropriate, for the same individual. The screening single contrast
barium enema also requires a written order from the beneficiary’s
attending physician in the same manner as described above for the
screening double contrast barium enema examination.

Effective January 1, 2023, the minimum age for Screening Barium
Enema Examinations 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.