D12.7: Benign neoplasm of rectosigmoid junction
D12.7, benign neoplasm of rectosigmoid junction, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 14 HCPCS Level II codes, including G0105 (Colorectal cancer screening; colonoscopy on individual at…), G9998 (Documentation of medical reason(s) for an interval of less…), G9999 (Documentation of system reason(s) for an interval of less…). 4 of these codes have a 2026 DMEPOS fee schedule amount; E0783 pays $9,917.33 to $11,667.45 (NU) depending on the state. The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with D12.7 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | Special coverage instructions apply | — | 1 |
| G9998 | Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes]) | Carrier judgment | — | 1 |
| G9999 | Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete) | Carrier judgment | — | 1 |
| E0783 | Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.) | Special coverage instructions apply | $9,917.33–$11,667.45 (NU) | 1 |
| E0786 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) | Special coverage instructions apply | $10,969.75–$11,380.88 (NU) | 1 |
| E0782 | Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.) | Special coverage instructions apply | $5,200.92–$6,118.73 (NU) | 1 |
| E0785 | Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement | Special coverage instructions apply | $572.38–$673.39 (KF) | 1 |
| J7999 | Compounded drug, not otherwise classified | Special coverage instructions apply | — | 1 |
| J2278 | Injection, ziconotide, 1 microgram | Special coverage instructions apply | — | 1 |
| J2274 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg | Special coverage instructions apply | — | 1 |
| A4220 | Refill kit for implantable infusion pump | Special coverage instructions apply | — | 1 |
| J9200 | Injection, floxuridine, 500 mg | Special coverage instructions apply | — | 1 |
| A9585 | Injection, gadobutrol, 0.1 ml | Carrier judgment | — | 1 |
| Q9953 | Injection, iron-based magnetic resonance contrast agent, per ml | Special coverage instructions apply | — | 1 |
Medicare policy articles listing D12.7
- A56632: Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy (Palmetto GBA (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L34005, L34454
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B); 9 Level II codes). LCD with the same title: L33461
- A57206: Billing and Coding: Lumbar MRI (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L34220
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other D12 diagnoses (Benign neoplasm of colon, rectum, anus and anal canal)
- D12.0 — Benign neoplasm of cecum
- D12.1 — Benign neoplasm of appendix
- D12.2 — Benign neoplasm of ascending colon
- D12.3 — Benign neoplasm of transverse colon
- D12.4 — Benign neoplasm of descending colon
- D12.5 — Benign neoplasm of sigmoid colon
- D12.8 — Benign neoplasm of rectum
- D12.9 — Benign neoplasm of anus and anal canal
Frequently asked questions
Does Medicare cover D12.7 (Benign neoplasm of rectosigmoid junction)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list D12.7 as a covered diagnosis for 14 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 D12.7?
The Level II codes from the policies most specific to this diagnosis are G0105 (Colorectal cancer screening; colonoscopy on individual at…, 1 article); G9998 (Documentation of medical reason(s) for an interval of less…, 1 article); G9999 (Documentation of system reason(s) for an interval of less…, 1 article); E0783 (Infusion pump system, implantable, programmable (includes…, 1 article); E0786 (Implantable programmable infusion pump, replacement…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with D12.7?
Under the 2026 DMEPOS fee schedule (non-rural state fees): E0783 $9,917.33 to $11,667.45 (NU); E0786 $10,969.75 to $11,380.88 (NU); E0782 $5,200.92 to $6,118.73 (NU); E0785 $572.38 to $673.39 (KF). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list D12.7?
A56632 (Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy); A56695 (Billing and Coding: Implantable Infusion Pump); A57206 (Billing and Coding: Lumbar MRI).
What is ICD-10-CM code D12.7?
D12.7 is the ICD-10-CM code for benign neoplasm of rectosigmoid junction, in category D12 (Benign neoplasm of colon, rectum, anus and anal canal), chapter 2: Neoplasms.
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 Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.