$348.58
Both describe screening colonoscopy, but G0105 is for a beneficiary meeting high-risk criteria; G0121 is for an individual who is not high risk.
On this page
CMS RVU26D · Effective 2026-10-01
G0105 Screening colonoscopy Medicare reimbursement rates in Kentucky
Report G0105 for a screening colonoscopy in a Medicare beneficiary who meets high-risk criteria, such as a relevant personal or family history. Compare G0105 office and facility rates across CMS payment localities in Kentucky.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0105 in Kentucky?
Kentucky has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$348.28
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$158.53
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Colorectal cancer screening
About G0105: High-risk screening colonoscopy
Report G0105 for a screening colonoscopy in a Medicare beneficiary who meets high-risk criteria, such as a relevant personal or family history.
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.
CMS billing rules for G0105
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.18 · 28%
- Practice expense (office) RVU7.73 · 68%
- Malpractice RVU0.41 · 4%
410.5K
Medicare services in 2024 · #251 by national volume
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.
G0105 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$194.06
G0104 is screening by flexible sigmoidoscopy, which examines less of the colon; G0105 is screening by colonoscopy for a high-risk individual.
$348.28
Use G0105 for a high-risk screening colonoscopy. Code 45378 is for a diagnostic colonoscopy, such as an examination prompted by symptoms.
Compare G0105 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Kentucky →
Office / nonfacility
$348.28
Facility
$158.53
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for G0105 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
15,087
- Code
- G0105
- Physician work
- 3.18
- Practice expense
- 7.73
- Malpractice
- 0.41
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.18 | × 1.000 | 3.1800 |
| Practice expense | 7.73 | × 0.889 | 6.8720 |
| Malpractice | 0.41 | × 0.915 | 0.3751 |
| Total RVUs | 10.4271 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$348.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.18 | 1 |
| Practice expense | 7.73 | 0.889 |
| Malpractice | 0.41 | 0.915 |
(3.18 × 1 + 7.73 × 0.889 + 0.41 × 0.915) × $33.4009 = $348.28
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.18 | 1 |
| Practice expense | 1.34 | 0.889 |
| Malpractice | 0.41 | 0.915 |
(3.18 × 1 + 1.34 × 0.889 + 0.41 × 0.915) × $33.4009 = $158.53
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
G0105 billing questions
How is G0105 different from G0121?
G0105 is for a screening colonoscopy when the beneficiary meets Medicare high-risk criteria. G0121 is the screening colonoscopy code for an individual who is not high risk.
When should G0104 be considered instead?
G0104 describes colorectal cancer screening by flexible sigmoidoscopy. G0105 is for screening by colonoscopy in a high-risk individual.
What documentation supports high-risk screening?
Record that the service was for screening and identify the history or other qualifying risk factor supporting high-risk status. The procedure report should document the examination and findings.
What does modifier 53 mean for G0105?
Modifier 53 identifies a procedure that was discontinued. CMS separately prices this modifier for G0105.
How does the multiple-procedure rule affect G0105?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for G0105. Co-surgeon and team-surgery billing are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,084G0102,,Prostate ca screening; dre,A,,0.18,0.54,,0.04,,0.01,0.73,0.23,0,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,085G0103,,Psa screening,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,086G0104,,Ca screen;flexi sigmoidscope,A,,0.82,5.50,,0.67,,0.11,6.43,1.60,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,087G0105,,Colorectal scrn; hi risk ind,A,,3.18,7.73,,1.34,,0.41,11.32,4.93,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,088G0105,53,Colorectal scrn; hi risk ind,A,,1.59,3.87,,0.67,,0.20,5.66,2.46,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,089G0108,,Diab manage trn per indiv,A,,0.90,0.73,,0.73,NA,0.04,1.67,1.67,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,090G0109,,Diab manage trn ind/group,A,,0.25,0.22,,0.22,NA,0.01,0.48,0.48,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631