Procedure code and Description
82270 Colorectal cancer screening; blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided three cards or single triple card for consecutive collection)
Medicare payment policy
Background: HCPCS code G0107 (Colorectal Cancer Screening; fecal-occult blood test, 1-3 simultaneous determinations) is currently being used for Medicare billing and payment of screening FOBT. HCPCS code G0107 will be retired effective January 1, 2007. It will be replaced for Medicare billing purposes by Current Procedural Terminology (Procedure ) code 82270 (Blood, occult, by peroxidase activity (e.g., Guaiac) qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection)).
Prior to January 1, 2007, both codes were in the HCPCS data set, but Medicare only recognized HCPCS code G0107 for billing and payment of screening FOBT. Effective on or after January 1, 2007, Procedure code 82270 will be used for billing and payment purposes by Medicare for screening FOBT. Therefore, when billing for FOBT screening services for claims with dates of service December 31, 2006 and earlier, physicians, suppliers and providers should use HCPCS code G0107; when billing for FOBT screening services for claims with dates of service January 1, 2007 and later, physicians, suppliers and providers should use Procedure code 82270.
B. Policy: Effective for claims with dates of service January 1, 2007 and later, physicians, suppliers and providers shall report current Procedure code 82270 in place of HCPCS code G0107 when billing for screening FOBT.
Payment (carrier and FI) is under the MPFS except as follows:
• Fecal occult blood tests (82270* (G0107*) and G0328) are paid under the clinical diagnostic lab fee schedule except reasonable cost is paid to CAHs when submitted on TOB 85X. Deductible and coinsurance do not apply for these tests.
See section A below for payment to Maryland waiver on TOB 13X. Payment from all hospitals for non-patient laboratory specimens on TOB 14X will be based on the clinical diagnostic fee schedule, including CAHs and Maryland waiver hospitals.
• Flexible sigmoidoscopy (code G0104) is paid under OPPS for hospital outpatient departments and on a reasonable cost basis for CAHs; or current payment methodologies for hospitals not subject to OPPS.
• Colonoscopy (G0105 and G0121) and barium enemas (G0106 and G0120) are paid under OPPS for hospital outpatient departments and on a reasonable costs basis for CAHs or current payment methodologies for hospitals not subject to OPPS. Also colonoscopies may be done in an Ambulatory Surgical Center (ASC) and when done in an ASC the ASC rate applies. The ASC rate is the same for diagnostic and screening colonoscopies.
Colorectal Cancer Screening
Medicare covers one screening fecal-occult blood test for women 50 years and older once every 12 months. The attending physician must submit a written order for the test.
Beginning January 1, 2007, the guaiac based screening should be reported to Medicare using CPT code 82270 rather than HCPCS code G0107. The descriptor for CPT code 82270 reads “Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection).” Therefore the patient must complete the test by taking samples from consecutive stools.
As an alternative to the guaiac-based fecal occult blood test, (FOBT), reported with CPT-4 code 82270, Medicare also covers screening performed by immunoassay. It is reported to Medicare using HCPCS code G0328 (colorectal cancer screening; fecal occult blood test immunoassay, 1-3 simultaneous). The number of specimens required depends on the individual manufacturer’s instructions. However, Medicare will pay for only one covered FOBT per year, either 82270 or G0328, but not both.
The diagnosis code reported is either V76.41 (special screening for malignant neoplasms, rectum) or V76.51 (special screening for malignant neoplasms, colon). The patient is not responsible for any copay or deductible.
HCPCS code G0107 (Colorectal Cancer Screening; fecal-occult blood test, 1-3 simultaneous determinations) is currently being used for Medicare billing and payment of screening FOBT. HCPCS code G0107 will be retired effective January 1, 2007. It will be replaced for Medicare billing purposes by Current Procedural Terminology (CPT) code 82270 (Blood, occult, by peroxidase activity (e.g., Guaiac) qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection)). Prior to January 1, 2007, both codes were in the HCPCS data set, but Medicare only recognized HCPCS code G0107 for billing and payment of screening FOBT. Effective on or after January 1, 2007, CPT code 82270 will be used for billing and payment purposes by Medicare for screening FOBT. Therefore, when billing for FOBT screening services for claims with dates of service December 31, 2006 and earlier, physicians, suppliers and providers should use HCPCS code G0107; when billing for FOBT screening services for claims with dates of service January 1, 2007 and later, physicians, suppliers and providers should use CPT code 82270.
Billing and Coding Guidelines
• Fecal occult blood tests (82270* (G0107*) and G0328) are paid under the clinical diagnostic lab fee schedule except reasonable cost is paid to CAHs when submitted on TOB 85X. Deductible and coinsurance do not apply for these tests. See section A below for payment to Maryland waiver on TOB 13X. Payment from all hospitals for non-patient laboratory specimens on TOB 14X will be based on the clinical diagnostic fee schedule, including CAHs and Maryland waiver hospitals.
Special Payment Instructions for Non-Patient Laboratory Specimen (TOB 14X) for all hospitals Payment for colorectal cancer screenings (82270* (G0107*) and G0328) to a hospital for a non-patient laboratory specimen (TOB 14X), is the lesser of the actual charge, the fee schedule amount, or the National Limitation Amount (NLA), (including CAHs and Maryland Waiver hospitals). Part B deductible and coinsurance do not apply.
Effective for services furnished on or after January 1, 1998, the following codes are used for colorectal cancer screening services:
• CPT 82270* (HCPCS G0107*) – Colorectal cancer screening; fecal-occult blood tests, 1-3 simultaneous determinations;
• HCPCS G0104 – Colorectal cancer screening; flexible sigmoidoscopy;
• HCPCS G0105 – Colorectal cancer screening; colonoscopy on individual at high risk;
• HCPCS G0106 – Colorectal cancer screening; barium enema; as an alternative to HCPCS G0104, screening sigmoidoscopy;
• HCPCS G0120 – Colorectal cancer screening; barium enema; as an alternative to HCPCS G0105, screening colonoscopy.
Effective for services furnished on or after July 1, 2001, the following codes are added for colorectal cancer screening services:
• HCPCS G0121 – Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk.
• HCPCS G0122 – Colorectal cancer screening; barium enema (noncovered).
The maximum amount Medicare will pay for a guaiac based screening FOBT
(CPT code 82270) is $4.54. In some states the reimbursement is less.
Fecal Occult Blood Test
• HCPCS/CPT Code 82270 or G0328 – Covered once every 12 months – Deductible and coinsurance waived
• Provides 3 single cards, or single triple card for consecutive collection, to return for testing
• 82270- Clinical lab fee
• Dx Z12.76 or Z12.11
Screening Fecal-Occult Blood Tests (FOBT) (Codes 82270 & G0328)
Effective for services furnished on or after January 1, 1998, one screening FOBT (82270) is covered for beneficiaries who have attained age 50, at a frequency of once every 12 months. Screening FOBT means: a guaiac-based test for peroxidase activity in which the beneficiary completes it by taking samples from two different sites of three consecutive stools.
Effective for services furnished on or after January 1, 2004, payment may be made for an immunoassaybased FOBT (G0328) as an alternative to the guaiac-based FOBT (82270). Medicare will pay for only one covered FOBT per year, either 82270 or G0328, but not both. Screening FOBT, immunoassay (G0328) includes the use of a spatula to collect the appropriate number of samples or the use of a special brush for the collection of samples, as determined by the individual manufacturer’s instructions.
