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Official Description

Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
Short Descr Colon ca scrn; barium enema
Coverage Special coverage instructions apply
Pricing Indicator(s) 11 – Physician Fee Schedule - Price established using national RVUs
MPI A – Not applicable, as HCPCS priced under one methodology
Processing Note COVERAGE AND PAYMENT BASED ON BALANCED BUDGET ACT OF 1997 (
BETOS I1D – Standard imaging - contrast gastrointestinal
TOS Code(s) 4 – Diagnostic radiology
Added Date 1/1/1998
Action Code D – Discontinue procedure or modifier code (effective 1/1/2025)
Termination Date 12/31/2024
Status Code Active Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Procedure or Service, Not Discounted when Multiple
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 186 - Lower gastrointestinal X-ray
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
RT Right side (used to identify procedures performed on the right side of the body)
SG Ambulatory surgical center (asc) facility service
Date
Action
Notes
2026-01-01 Deleted First appearance of deletion in codebook.
2024-12-31 Deleted Code deleted.
1998-01-01 Added Code Added
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