G0105 — Colorectal cancer screening; colonoscopy on individual at high risk

What the market charges

Across 2,729 negotiated rates, the middle 80% fall between $188 and $1,126, with a median of $504.

What Medicare pays

Medicare allowed an average of $288 for this code, across 364,912 services billed by 8,537 providers. At the median, the market charges 1.8 times what Medicare pays for this code.

Where this is billed, and what it costs there

The states billing G0105 most, by Medicare service volume, each compared against the national average of $288. Each links to the providers Mishe lists there.

• Florida — 664 providers billed it, Medicare allowed $293 — 2% above the national average
• California — 613 providers billed it, Medicare allowed $362 — 26% above the national average
• Texas — 608 providers billed it, Medicare allowed $285 — 1% below the national average
• Pennsylvania — 503 providers billed it, Medicare allowed $281 — 2% below the national average
• North Carolina — 334 providers billed it, Medicare allowed $289 — level with the national average
• Massachusetts — 262 providers billed it, Medicare allowed $270 — 6% below the national average
• Ohio — 341 providers billed it, Medicare allowed $270 — 6% below the national average
• Georgia — 295 providers billed it, Medicare allowed $291 — 1% above the national average

Claim-editing rules

These are National Correct Coding Initiative procedure-to-procedure edits — the rules a payer applies when deciding whether two codes billed together are both payable.

Codes this one absorbs

Billed together, G0105 is the payable code and these are not separately payable. 229 pairs in total.

• 12001 — a modifier may allow both to be paid
• 12002 — a modifier may allow both to be paid
• 12004 — a modifier may allow both to be paid
• 12005 — a modifier may allow both to be paid
• 12006 — a modifier may allow both to be paid
• 12007 — a modifier may allow both to be paid
• 12011 — a modifier may allow both to be paid
• 12013 — a modifier may allow both to be paid
• 12014 — a modifier may allow both to be paid
• 12015 — a modifier may allow both to be paid
• 12016 — a modifier may allow both to be paid
• 12017 — a modifier may allow both to be paid

Codes that absorb this one

Billed alongside any of these, G0105 is not separately payable. 19 pairs in total.

• 45349 — no modifier can override this edit
• 45378 — no modifier can override this edit
• 45379 — no modifier can override this edit
• 45380 — no modifier can override this edit
• 45381 — no modifier can override this edit
• 45382 — no modifier can override this edit
• 45384 — no modifier can override this edit
• 45385 — no modifier can override this edit
• 45386 — no modifier can override this edit
• 45388 — no modifier can override this edit
• 45389 — no modifier can override this edit
• 45390 — no modifier can override this edit

Other codes

• J2777 — Injection, faricimab-svoa, 0.1 mg
• J0897 — Injection, denosumab, 1 mg
• J9271 — Injection, pembrolizumab, 1 mg
• J0129 — Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
• G0008 — Administration of influenza virus vaccine
• G0439 — Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
• J9144 — Injection, daratumumab, 10 mg and hyaluronidase-fihj
• J9299 — Injection, nivolumab, 1 mg
• J1745 — Injection, infliximab, excludes biosimilar, 10 mg
• J2357 — Injection, omalizumab, 5 mg

Deploy this for your team

Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.

• Contact Mishe to learn how to deploy these resources for your team
• Guides to direct-pay healthcare
• Cash prices by procedure
• Find a provider by state

Take back healthcare.