Does G9999 require prior authorization?

No, G9999 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G9999?

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

Verity

`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)

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

When performed for surveillance of colonic neoplasia, report the appropriate CPT/HCPCS procedure code and the appropriate primary ICD-10-CM code plus one of the following secondary diagnosis codes: Z85.038, Z85.048, Z86.0100, Z86.0101, Z86.0102, or Z86.0109.
For high-risk post-surgical follow-up at 1 year (with continued 24-month screening eligibility), report HCPCS code G0105 as the appropriate screening/high-risk colonoscopy code.

Provider/supplier must notify the beneficiary in writing prior to rendering the service if the provider is aware the test/procedure may not be covered by Medicare; limitation of liability and refund requirements apply when denials are likely.

Key Coverage Criteria

Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
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.

2 Active Policies

A56632 — Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

L34454 — Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

`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)

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

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)

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`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)