G0104 HCPCS code: Colorectal cancer screening; flexible sigmoidoscopy
G0104 is the HCPCS Level II code for colorectal cancer screening; flexible sigmoidoscopy. In 2024 Medicare paid an average of $75.24 per service for G0104 across 3,822 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume rose 4% from 2022 to 2024 (3,680 to 3,822 services). In 2024, about 2,337 clinicians billed Medicare for G0104 for 3,230 beneficiaries; Florida, Texas, California accounted for 34% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | P8C |
| Added | 1998-01-01 |
| Last action effective | 1998-01-01 |
Who bills G0104 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,337 |
| Medicare beneficiaries | 3,230 |
| States with claims | 46 |
| Share of services in top 3 states (Florida, Texas, California) | 34% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0104, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,680 | 3,035 | $80.40 | $80.40 |
| 2023 | 4,016 | 3,305 | $76.79 | $76.79 |
| 2024 | 3,822 | 3,230 | $75.24 | $75.24 |
States with the most G0104 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 668 | $72.73 |
| Texas | 302 | $65.38 |
| California | 298 | $90.54 |
| Pennsylvania | 229 | $79.32 |
| Ohio | 192 | $72.59 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Anatomic Consideration |
| practitioner claims | 1 | Anatomic Consideration |
What changed for G0104
- 1998-01-01: G0104 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0104?
G0104 is the HCPCS Level II code for colorectal cancer screening; flexible sigmoidoscopy. Short descriptor: "Ca screen;flexi sigmoidscope".
How much does Medicare pay for G0104?
In 2024, the average Medicare payment was $75.24 per service (average allowed $75.24).
Does Medicare cover G0104?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of G0104 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G01 codes
- G0101 — Cervical or vaginal cancer screening; pelvic and clinical breast examination
- G0102 — Prostate cancer screening; digital rectal examination
- G0103 — Prostate cancer screening; prostate specific antigen test (PSA)
- G0105 — Colorectal cancer screening; colonoscopy on individual at high risk
- G0106 — Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
- G0108 — Diabetes outpatient self-management training services, individual, per 30 minutes
- G0109 — Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
- G0117 — Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
- G0118 — Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
- G0120 — Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
- G0121 — Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
- G0122 — Colorectal cancer screening; barium enema
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under G0104
- Watch G0104 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0104
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.