HCPCS Code G0106: Colorectal cancer screening (deleted)

Key takeaways

HCPCS Code G0106 covered colorectal cancer screening by barium enema as an alternative to G0104, and CMS has deleted it.

Submitting G0106 on a Medicare claim today triggers an automatic denial at the code-validation stage.

Active replacement codes include G0104, G0105, G0121, 45378, and 82270, depending on the screening method and patient risk level.

Pair every screening claim with Z12.11, and confirm the coverage interval has reopened before you bill.

Pabau’s claims management software flags deleted HCPCS codes before submission, preventing the most common denial caused by G0106.

HCPCS Code G0106 covered colorectal cancer screening by barium enema, billed as an alternative to G0104. The Centers for Medicare and Medicaid Services (CMS) has deleted it from the HCPCS Level II code set.

CMS maintains that code set for Medicare and Medicaid billing. Claims submitted with G0106 today deny immediately at the code-validation stage.

The official descriptor read: Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy; barium enema. G0106 was a CMS-maintained G-code, so it sat in the HCPCS Level II schedule rather than the AMA’s CPT code set.

That letter matters when you are looking a code up. HCPCS Level II runs in letter series, and the series tells you what kind of item a code describes. G-codes cover professional procedures and services.

Supply codes such as A4601 sit in the A series, and infusion and nutrition therapy codes such as B9002 sit in the B series.

Is G0106 active or deleted?

G0106 is deleted. CMS removed it from the active HCPCS Level II schedule as part of updates to colorectal cancer screening policy. Any claim carrying this code rejects at the payer’s code-validation step, before it reaches adjudication.

There is no grace period, no workaround modifier, and no Medicare Administrative Contractor (MAC) jurisdiction where G0106 is still payable.

Billers who inherit an old charge master or work from outdated coding templates may still have G0106 loaded. Replace it with the correct active code from the crosswalk in the next section. Then check that your billing system is not auto-populating deleted codes on preventive screening claims.

G0106 vs. G0104: What is the difference?

G0106 and G0104 both covered colorectal cancer screening for average-risk Medicare beneficiaries. The procedure behind each code is what differed. G0104 described a screening flexible sigmoidoscopy, while G0106 described a barium enema used when sigmoidoscopy was not appropriate or available.

G0104 remains active, so verify its status against the current CMS Physician Fee Schedule before billing. G0106 is deleted.

Barium enema counted as an equivalent screening alternative when sigmoidoscopy was contraindicated, and that clinical distinction is what separated the two codes.

What replaced G0106?

CMS does not name a single official replacement when it deletes a code. Bill the active code that best describes the procedure you actually performed. For screening previously billed under G0106, the right code depends on the screening method and the patient’s risk category.

Verify each replacement code’s current status against the AAPC HCPCS code reference or the CMS annual HCPCS update file before billing. Code statuses change each fiscal year.

Most former G0106 volume lands on one of two codes. Average-risk patients screened by colonoscopy are billed under G0121. When the intent is diagnostic rather than preventive, 45378 applies instead.

Medicare coverage for colorectal cancer screening

Medicare Part B covers colorectal cancer screening as a preventive benefit under CMS National Coverage Determination (NCD) 210.3. Beneficiaries usually pay nothing when the service is preventive rather than diagnostic. Cost-sharing can change if the encounter converts to a diagnostic procedure, so verify current rules with your MAC before you quote a patient a price.

Covered methods under Part B generally include fecal occult blood tests (FOBT), flexible sigmoidoscopy, colonoscopy, and stool DNA tests. Anesthesia furnished with a screening colonoscopy is covered as part of the benefit, and it is billed with 00812.

Barium enema on its own is no longer supported under NCD 210.3, which is part of why G0106 came out of the code set.

Billers in primary care carry most of this work, because that is where preventive screening is ordered and tracked. Audit the charge master once a year against current NCD and Local Coverage Determination (LCD) requirements.

How often Medicare covers each screening test

Medicare’s frequency rules differ by test type and patient risk level. A claim submitted before the beneficiary’s coverage window reopens denies even when the code is right. The table below reflects general CMS guidance, so verify it against current NCD 210.3 and your MAC’s LCD. Intervals can be updated annually.

High-risk status covers a personal or family history of colorectal cancer or adenomatous polyps, Crohn’s disease, ulcerative colitis, and certain hereditary syndromes. Document the clinical basis for that designation in the medical record, so the shorter interval holds up when the claim is audited.

Tracking intervals by hand across a whole patient panel is where recalls slip. Practices running preventive programs, including men’s health practices, use patient recall software to surface each patient as the window reopens.

ICD-10 codes that pair with a screening claim

Colorectal screening HCPCS and CPT codes need a supporting ICD-10-CM diagnosis code. Z12.11 is the primary pairing code for most screening claims, per the CDC/NCHS ICD-10-CM tabular list. A missing or invalid Z-code pairing is the second common denial source, separate from a deleted procedure code.

The Z-code is what signals screening intent. When the patient arrives with symptoms instead, the encounter is diagnostic, and it pairs with a symptom code such as R12 rather than Z12.11.

Your MAC may add LCD-specific pairing requirements. AAPC and Noridian MAC guidance both confirm Z12.11 as the standard primary code.

Check your own MAC’s policy for edge cases, particularly when a screening procedure converts to diagnostic intent mid-encounter.

Billing guidelines and documentation requirements

Swapping the code is only half the job. A colorectal screening claim still has to meet Medicare’s documentation and billing standards, and this checklist covers what to verify before submission.

• Use an active procedure code. Select from G0104, G0105, G0121, 82270, G0328, or the CPT code that matches the procedure performed.
• Pair with a valid ICD-10-CM code. Use Z12.11 for average-risk screening, and add a high-risk Z-code or condition code where it applies.
• Confirm beneficiary eligibility. Medicare covers colorectal screening from age 45 under current CMS policy. Verify the patient’s age and prior claim history.
• Check the screening interval. Confirm the beneficiary has not had the same screening type inside the coverage window, using Medicare’s Common Working File (CWF) or your eligibility tool.
• Document medical necessity for high-risk coding. If you bill G0105, the record must support the risk designation with family history, personal history, or a qualifying chronic condition.
• Place of service. Screening colonoscopies are commonly billed under POS 24 (ambulatory surgical center), POS 22 (outpatient hospital), or POS 11 (office). Confirm the POS code matches where the procedure happened.
• Do not use G0106. It will deny even when a legacy system or an old charge master still offers it. Remove it from every active code set.

Practices with integrated EHR and billing integrations can automate several of these checks before claims go out. Documentation captured at the point of care feeds straight into claim preparation, which shortens the wait between the visit and submission.

Common billing errors and claim denials

Denials on colorectal screening claims cluster into a handful of causes. G0106 denials are the most avoidable of them, because the whole fix is a code swap.

A polyp removed during a screening colonoscopy converts the encounter on the spot. The claim then moves to a diagnostic code such as 45380, and the patient may owe cost-sharing nobody warned them about.

Practices on integrated practice management platforms report fewer coding errors at submission, because validation runs before the claim leaves the system. Manual charge master reviews catch errors only once the denials arrive, which pushes avoidable rework back into the revenue cycle.

How Pabau flags deleted codes before a claim goes out

Deleted HCPCS codes come back around every year. G0106 will not be the last colorectal screening code billers have to watch. CMS rewrites its annual code file, and a code that paid last year can turn invalid. A practice that relies on manual charge master updates alone stays one review cycle behind that file.

Practice management software like Pabau runs claims validation at the point of charge entry. It checks submitted procedure codes against current active code sets before a claim leaves the system.

When G0106 or another deleted code appears, the biller sees a flag and a prompt to pick the active replacement. The correction happens while the claim is still in your hands.

Pabau’s claims management software runs that check for practices with preventive care programs. Clinical documentation sits in the same record, so the note supporting a high-risk G0105 designation is there at claim review. Nobody has to open a second system to find it.

The outcome is a shorter month-end. Fewer preventive claims come back, your billers spend their time on real payer questions, and the practice gets paid on the first pass. That holds whether you bill for one provider or handle medical practice management across several.

Stop claim denials before they start

Pabau's claims management software validates HCPCS codes against active CMS code sets before submission – flagging deleted codes like G0106 and prompting the correct active replacement. See how it works for your preventive care billing.

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Conclusion

Correcting G0106 on one claim takes a minute. Keeping it off every future claim takes a process, and that is the trade-off worth remembering. A code that denies silently costs far more in rework than the annual review that would have caught it.

So reconcile the charge master against CMS’s updated HCPCS file every year. Put the validation step in front of submission, rather than the correction step behind it.

Practices that automate this validation step with a tool like Pabau’s claims management software catch deleted codes before submission rather than after a denial. Book a demo to see that check run on a preventive claim before it reaches your MAC.

Continue your research

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