Does G2204 require prior authorization?

No, G2204 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G2204?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Select the CPT code that accurately describes the diagnostic/therapeutic procedure that was performed or attempted during the colonoscopy.
Append the -PT modifier to the selected CPT code to indicate a screening colonoscopy was converted to a diagnostic or therapeutic procedure.
Use an appropriate ICD-10 diagnosis code indicating the procedure was a screening (example: Z80.0) when submitting the claim for a converted screening colonoscopy.
Document clinical findings in the medical record that demonstrate the screening colonoscopy was converted to diagnostic/therapeutic (e.g., description of encountered pathology and performed intervention).

If a screening colonoscopy encounters pathology that necessitates intervention converting it to a diagnostic or therapeutic colonoscopy, bill using the appropriate diagnostic/therapeutic CPT code appended with the -PT modifier and an appropriate screening ICD-10 diagnosis.
When beneficiaries are at high risk for colorectal malignancy, an ICD-10 screening code such as Z80.0 (family history of malignant neoplasm of digestive organs) may be used to indicate the procedure was a screening converted to diagnostic/therapeutic.
Colonoscopy to evaluate an abnormality on barium enema or other imaging likely to be clinically significant (e.g., filling defect, stricture, inadequate exam).
Evaluation of unexplained gastrointestinal bleeding including hematochezia not thought to be from a rectal/perianal source, melena of unknown origin, or presence of fecal occult blood.
Evaluation of unexplained iron deficiency anemia.
Surveillance examination of the entire colon to evaluate for synchronous colonic cancer or polyps in a patient with treatable cancer or polyps.

A55069 — Billing and Coding: Screening Colonoscopy Converted to a Diagnostic and/or Therapeutic Colonoscopy

L34454 — Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

Ask Verity about documentation requirements, denial risks, or coverage in your state.