Colorectal Cancer Screening CPT CODE and covered dx v76.41

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.