G0105 HCPCS code: Colorectal cancer screening; colonoscopy on individual at high risk
G0105 is the HCPCS Level II code for colorectal cancer screening; colonoscopy on individual at high risk. In 2024 Medicare paid an average of $276.97 per service for G0105 across 410,501 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 fell 3% from 2022 to 2024 (423,742 to 410,501 services). In 2024, about 20,236 clinicians billed Medicare for G0105 for 283,969 beneficiaries; Florida, California, Texas accounted for 23% 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 | P8D |
| Added | 1998-01-01 |
| Last action effective | 1998-01-01 |
Who bills G0105 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 20,236 |
| Medicare beneficiaries | 283,969 |
| States with claims | 55 |
| Share of services in top 3 states (Florida, California, Texas) | 23% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0105, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 423,742 | 290,216 | $252.30 | $252.30 |
| 2023 | 427,908 | 294,143 | $265.12 | $265.12 |
| 2024 | 410,501 | 283,969 | $276.97 | $276.97 |
States with the most G0105 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 37,080 | $287.19 |
| California | 30,014 | $346.35 |
| Texas | 28,488 | $276.55 |
| Pennsylvania | 24,369 | $270.03 |
| North Carolina | 15,961 | $279.70 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Anatomic Consideration |
| practitioner claims | 1 | Anatomic Consideration |
Medicare policy articles for this code
- A55069: Billing and Coding: Screening Colonoscopy Converted to a Diagnostic and/or Therapeutic Colonoscopy (Palmetto GBA (MAC - Part A, MAC - Part B))
- A55227: Billing and Coding: Incomplete Colonoscopy/Failed Colonoscopy (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56632: Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (558 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| Z12.11 | Encounter for screening for malignant neoplasm of colon | 3 |
| Z15.060 | Genetic susceptibility to colorectal cancer | 3 |
| Z80.0 | Family history of malignant neoplasm of digestive organs | 3 |
| A03.9 | Shigellosis, unspecified | 1 |
| A04.3 | Enterohemorrhagic Escherichia coli infection | 1 |
| A04.5 | Campylobacter enteritis | 1 |
| A04.6 | Enteritis due to Yersinia enterocolitica | 1 |
| A04.71 | Enterocolitis due to Clostridium difficile, recurrent | 1 |
| A04.72 | Enterocolitis due to Clostridium difficile, not specified as recurrent | 1 |
| A04.8 | Other specified bacterial intestinal infections | 1 |
Showing 10 of 558. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for G0105
- 1998-01-01: G0105 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 G0105?
G0105 is the HCPCS Level II code for colorectal cancer screening; colonoscopy on individual at high risk. Short descriptor: "Colorectal scrn; hi risk ind".
How much does Medicare pay for G0105?
In 2024, the average Medicare payment was $276.97 per service (average allowed $276.97).
Does Medicare cover G0105?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for G0105?
Medicare policy articles that cite G0105 list 558 covered ICD-10-CM diagnosis codes across 3 articles. The most cited include Z12.11 (Encounter for screening for malignant neoplasm of colon), Z15.060 (Genetic susceptibility to colorectal cancer), Z80.0 (Family history of malignant neoplasm of digestive organs). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of G0105 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)
- G0104 — Colorectal cancer screening; flexible sigmoidoscopy
- 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 G0105
- Watch G0105 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0105
Sources: CMS HCPCS Level II release October 2025; 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.