Key facts for G0104
- Medicare payment
- $214.77
- PFS non-facility, national; facility $53.44
- Coverage code
- D
- special coverage instructions apply
- Practitioner MUE
- 1
- MAI 2
- NCCI PTP pairs
- 332
- 301 hospital outpatient
- LCDs and articles
- 0 / 0
TL;DR
CMS describes HCPCS G0104, added in 1998, as "Colorectal cancer screening; flexible sigmoidoscopy". Under the 2026 physician fee schedule (October release) G0104 carries 0.82 work, 5.50 practice-expense and 0.11 malpractice RVUs, which at $33.4009 per RVU pays $214.77 non-facility and $53.44 facility before the locality adjustment. Qualifying APM participants get $215.84 at $33.5675. Global period 000 (0-day global period). Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration). G0104 is a primary code for 1 add-on code (G0513). In the NCCI PTP files v323r0 G0104 appears in 13 practitioner pairs as column 2 and 319 as column 1 (most often with 0885T, 0886T, 45346), and in 13 hospital outpatient pairs as column 2 and 288 as column 1. No current LCD or billing article lists G0104; its HCPCS coverage code is D (special coverage instructions apply). HCPCS record: BETOS P8C (endoscopy - sigmoidoscopy); pricing indicator 11; type of service 2 (surgery). 4 other active codes open with "Colorectal cancer screening"; related codes: G0105, G0121, G0327, G0328.
G0104 descriptor and code status
The October 2026 HCPCS Level II file describes G0104 as “Colorectal cancer screening; flexible sigmoidoscopy”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.
| Field | Value |
|---|---|
| Short descriptor | Ca screen;flexi sigmoidscope |
| Added to HCPCS | 1998-01-01 |
| Last action | N (no maintenance), effective 1998-01-01 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 11: physician fee schedule, priced with national RVUs |
| BETOS category | P8C: endoscopy - sigmoidoscopy |
| Type of service | 2: surgery |
Medicare payment for G0104
Under the 2026 physician fee schedule (October release) G0104 carries 0.82 work, 5.50 practice-expense and 0.11 malpractice RVUs, which at $33.4009 per RVU pays $214.77 non-facility and $53.44 facility before the locality adjustment. Qualifying APM participants get $215.84 at $33.5675. Global period 000 (0-day global period). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.
Physician fee schedule (RVU26D)
Status A: active: paid separately under the physician fee schedule when covered. Global period 000 (0-day global period); PC/TC indicator 0 (physician service; the professional/technical split does not apply).
| Component | Non-facility | Facility |
|---|---|---|
| Work RVU | 0.82 | 0.82 |
| Practice expense RVU | 5.50 | 0.67 |
| Malpractice RVU | 0.11 | 0.11 |
| Total RVUs | 6.43 | 1.60 |
| National payment (CF $33.4009) | $214.77 | $53.44 |
| Qualifying APM participant (CF $33.5675) | $215.84 | $53.71 |
- Multiple procedures (modifier 51): standard multiple-procedure reduction (100%, then 50%)
- Bilateral (modifier 50): 150% bilateral adjustment does not apply
- Assistant at surgery: assistant at surgery may not be paid; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
- Physician supervision of diagnostic procedures: supervision concept does not apply
Hospital outpatient (OPPS Addendum B)
Status indicator T (Procedure or service, multiple reduction applies), APC 5311 (Level 1 Lower GI Procedures), national unadjusted payment $950.10 with a minimum unadjusted copayment of $0.00.
Ambulatory surgical center (Addendum AA)
Payment indicator P3 (Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs), national rate $184.96. The multiple-procedure discount applies when it is billed with another ASC procedure.
Medically Unlikely Edits for G0104
Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 2 Date of Service Edit: Policy | Anatomic Consideration |
| Facility outpatient hospital | 1 | 2 Date of Service Edit: Policy | Anatomic Consideration |
The MUE lookup for G0104 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0104 is the column-2 (bundled) code in 13 active pairs, 0% of which allow a modifier and the column-1 code in 319 (67% modifier-allowed); 297 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.
| Column-1 code | Pairs |
|---|---|
| 0885T (CPT; descriptor licensed by AMA) | 1 |
| 0886T (CPT; descriptor licensed by AMA) | 1 |
| 45346 (CPT; descriptor licensed by AMA) | 1 |
| 45347 (CPT; descriptor licensed by AMA) | 1 |
| 45349 (CPT; descriptor licensed by AMA) | 1 |
| 45350 (CPT; descriptor licensed by AMA) | 1 |
| 45388 (CPT; descriptor licensed by AMA) | 1 |
| 45389 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0091U (CPT; descriptor licensed by AMA) | 1 |
| 0163U (CPT; descriptor licensed by AMA) | 1 |
| 0213T (CPT; descriptor licensed by AMA) | 1 |
| 0216T (CPT; descriptor licensed by AMA) | 1 |
| 0405U (CPT; descriptor licensed by AMA) | 1 |
| 0421U (CPT; descriptor licensed by AMA) | 1 |
| 0460U (CPT; descriptor licensed by AMA) | 1 |
| 0461U (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0104 is the column-2 (bundled) code in 13 active pairs, 0% of which allow a modifier and the column-1 code in 288 (85% modifier-allowed); 174 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.
| Column-1 code | Pairs |
|---|---|
| 0885T (CPT; descriptor licensed by AMA) | 1 |
| 0886T (CPT; descriptor licensed by AMA) | 1 |
| 45346 (CPT; descriptor licensed by AMA) | 1 |
| 45347 (CPT; descriptor licensed by AMA) | 1 |
| 45349 (CPT; descriptor licensed by AMA) | 1 |
| 45350 (CPT; descriptor licensed by AMA) | 1 |
| 45388 (CPT; descriptor licensed by AMA) | 1 |
| 45389 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0091U (CPT; descriptor licensed by AMA) | 1 |
| 0163U (CPT; descriptor licensed by AMA) | 1 |
| 0213T (CPT; descriptor licensed by AMA) | 1 |
| 0216T (CPT; descriptor licensed by AMA) | 1 |
| 0405U (CPT; descriptor licensed by AMA) | 1 |
| 0421U (CPT; descriptor licensed by AMA) | 1 |
| 0460U (CPT; descriptor licensed by AMA) | 1 |
| 0461U (CPT; descriptor licensed by AMA) | 1 |
G0104 is a designated primary code for 1 add-on code (G0513).
Pair counts show exposure, not the answer for one claim. Check G0104 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0104
No current LCD or billing and coding article lists G0104. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.
Denials to expect on G0104
the modifier reported is inconsistent with the code
the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier
Where QuickIntell fits for G0104 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0104 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS G0104
What does HCPCS code G0104 describe?
"Colorectal cancer screening; flexible sigmoidoscopy" (short descriptor "Ca screen;flexi sigmoidscope"), in the G section (procedures and professional services, temporary). Added 1998-01-01.
Is G0104 a CPT code?
No. G0104 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0104 CPT code" mean this Level II code.
What does Medicare pay for G0104?
Under the 2026 physician fee schedule (October release) G0104 carries 0.82 work, 5.50 practice-expense and 0.11 malpractice RVUs, which at $33.4009 per RVU pays $214.77 non-facility and $53.44 facility before the locality adjustment. Qualifying APM participants get $215.84 at $33.5675. Global period 000 (0-day global period).
Is G0104 an add-on code?
G0104 is a primary code for 1 add-on code (G0513).
How many units of G0104 can be billed per day?
Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.
Does Medicare cover G0104?
No current LCD or billing article lists G0104; its HCPCS coverage code is D (special coverage instructions apply).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- ASC Addendum AA (covered surgical procedures), October 2026Version October 2026 · effective 2026-10-01 · file Oct 2026 ASC AA.txtSHA-256 bc3479589b7b1f23…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
- NCCI Add-On Code edits, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file AOC_V2026Q4-F-MCR.xlsxSHA-256 eabb519623134549…
Disclaimer
This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.