Z12.11: Encounter for screening for malignant neoplasm of colon

Z12.11, encounter for screening for malignant neoplasm of colon, is listed as a covered diagnosis in 5 Medicare billing and coding articles that apply to 24 HCPCS Level II codes, including G0105 (Colorectal cancer screening; colonoscopy on individual at…), G0121 (Colorectal cancer screening; colonoscopy on individual not…), G2204 (Patients between 45 and 85 years of age who received a…). The articles come from 3 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 Z12.11 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
G0105Colorectal cancer screening; colonoscopy on individual at high riskSpecial coverage instructions apply—3
G0121Colorectal cancer screening; colonoscopy on individual not meeting criteria for high riskSpecial coverage instructions apply—1
G2204Patients between 45 and 85 years of age who received a screening colonoscopy during the performance periodCarrier judgment—1
J2785Injection, regadenoson, 0.1 mgCarrier judgment—2
J0461Injection, atropine sulfate, 0.01 mgSpecial coverage instructions apply—2
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—2
Q9957Injection, perflutren lipid microspheres, per mlCarrier judgment—2
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—2
J0280Injection, aminophyllin, up to 250 mgSpecial coverage instructions apply—2
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—2
Q9956Injection, octafluoropropane microspheres, per mlCarrier judgment—2
A9700Supply of injectable contrast material for use in echocardiography, per studySpecial coverage instructions apply—2
C8921Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; completeSpecial coverage instructions apply—2
C8922Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited studySpecial coverage instructions apply—2
C8923Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiographySpecial coverage instructions apply—2
C8924Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited studySpecial coverage instructions apply—2
C8928Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and reportSpecial coverage instructions apply—2
C8929Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiographySpecial coverage instructions apply—2
C8930Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervisionSpecial coverage instructions apply—2
Q9955Injection, perflexane lipid microspheres, per mlCarrier judgment—2
G9998Documentation 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
G9999Documentation 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
J3490Unclassified drugsSpecial coverage instructions apply—1
C9399Unclassified drugs or biologicalsSpecial coverage instructions apply—1

Medicare policy articles listing Z12.11

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.

Frequently asked questions

Does Medicare cover Z12.11 (Encounter for screening for malignant neoplasm of colon)?

Medicare covers items and services, not diagnoses. 5 Medicare billing and coding articles list Z12.11 as a covered diagnosis for 24 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 Z12.11?

The Level II codes from the policies most specific to this diagnosis are G0105 (Colorectal cancer screening; colonoscopy on individual at…, 3 articles); G0121 (Colorectal cancer screening; colonoscopy on individual not…, 1 article); G2204 (Patients between 45 and 85 years of age who received a…, 1 article); J2785 (Injection, regadenoson, 0.1 mg, 2 articles); J0461 (Injection, atropine sulfate, 0.01 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list Z12.11?

A55069 (Billing and Coding: Screening Colonoscopy Converted to a Diagnostic and/or Therapeutic Colonoscopy); A55227 (Billing and Coding: Incomplete Colonoscopy/Failed Colonoscopy); A56632 (Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy), and 2 more articles.

What is ICD-10-CM code Z12.11?

Z12.11 is the ICD-10-CM code for encounter for screening for malignant neoplasm of colon, in category Z12 (Encounter for screening for malignant neoplasms), chapter 22: Factors influencing health status and contact with health services.

Next steps

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.

Chapter 22: Factors influencing health status and contact with health services · All diagnoses · HCPCS lookup