HCPCS code G0105: Screening colonoscopy, high-risk individual2026 Medicare rate & RVUs

Medicare pays $378.10 for G0105 nationally in the office and $164.67 in a hospital or facility. Local office rates run $335.05–$497.55.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What G0105 covers

G0105 represents a colonoscopic examination performed to screen an asymptomatic beneficiary who qualifies as high risk for colorectal cancer. A gastroenterologist, colorectal surgeon, or other qualified endoscopist examines the colon, typically in an ambulatory endoscopy center or hospital outpatient department. High-risk circumstances can include a personal history of colorectal cancer or adenomatous polyps, inflammatory bowel disease, or colorectal cancer in a first-degree relative. The indication should support screening rather than evaluation of current symptoms.

Document the screening purpose, the risk factor supporting high-risk status, and the endoscopy findings and extent. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 53 is separately priced for a discontinued procedure. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where G0105 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

G0105 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the G0105 rate is calculated

Each of G0105’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for G0105

The CMS indicators that decide how G0105 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

G0105 compared with similar codes

How to choose

G0121Screening colonoscopyNot high risk

Both describe screening colonoscopy, but G0105 is for a beneficiary meeting high-risk criteria; G0121 is for an individual who is not high risk.

G0104Flexible sigmoidoscopyColorectal cancer screening

G0104 is screening by flexible sigmoidoscopy, which examines less of the colon; G0105 is screening by colonoscopy for a high-risk individual.

45378ColonoscopyDiagnostic, no tissue removal

Use G0105 for a high-risk screening colonoscopy. Code 45378 is for a diagnostic colonoscopy, such as an examination prompted by symptoms.

Codes related to G0105

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates