$356.17–$393.24
G0105 describes colorectal screening by colonoscopy for a high-risk patient; G0104 describes screening by flexible sigmoidoscopy.
On this page
CMS RVU26D · Effective 2026-10-01
G0104 Flexible sigmoidoscopy Medicare reimbursement rates in Pennsylvania
Report G0104 for a Medicare colorectal cancer screening performed with a flexible sigmoidoscope to examine the rectum and distal colon. Compare G0104 office and facility rates across CMS payment localities in Pennsylvania.
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 G0104 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$199.50–$223.50
2 of 2 localities have a supported rate.
Facility setting
$51.40–$55.56
2 of 2 localities have a supported rate.
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 screening
About G0104: Screening flexible sigmoidoscopy
Report G0104 for a Medicare colorectal cancer screening performed with a flexible sigmoidoscope to examine the rectum and distal colon.
G0104 represents a colorectal cancer screening examination using a flexible scope to inspect the rectum and sigmoid colon. It is intended for screening rather than evaluation of symptoms. Gastroenterologists, colorectal surgeons, and other qualified physicians commonly perform the procedure in an outpatient endoscopy center or hospital department. The record should identify the screening purpose, the procedure performed, its findings, and any intervention.
Report one screening procedure, supported by documentation of the clinical indication and examination. The code has a 0-day global period, so routine same-day preoperative and postoperative care is included. When other procedures subject to the CMS multiple-procedure reduction occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this single endoscopic service. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for G0104
- 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 RVU0.82 · 13%
- Practice expense (office) RVU5.50 · 86%
- Malpractice RVU0.11 · 2%
3.8K
Medicare services in 2024 · #2027 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.
G0104 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$356.49–$393.64
G0121 is the colonoscopy screening code for a patient not classified as high risk. G0104 is the flexible sigmoidoscopy screening code.
$199.82–$223.90
45330 describes diagnostic flexible sigmoidoscopy. G0104 is for a screening examination, not a procedure prompted by symptoms or a diagnostic indication.
$299.67–$336.09
45331 is a diagnostic flexible sigmoidoscopy code when biopsy is performed; G0104 represents colorectal screening by flexible sigmoidoscopy.
Compare G0104 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$223.50
Facility
$55.56
Rest Of Pennsylvania →
Office / nonfacility
$199.50
Facility
$51.40
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
G0104 billing questions
How is G0104 different from a diagnostic flexible sigmoidoscopy?
G0104 is for a colorectal cancer screening examination. Use a diagnostic sigmoidoscopy code, such as 45330, when the procedure is performed to investigate a symptom or other diagnostic indication.
Should modifier 50 be reported?
No. This is a single endoscopic screening service, not a bilateral procedure; modifier 50 is inappropriate.
Is routine same-day evaluation separately included?
Routine same-day preoperative and postoperative care is included under the 0-day global period.
What happens when another procedure is performed in the same session?
Under the CMS multiple-procedure reduction, the highest-valued procedure is paid in full and the other qualifying procedures are paid at 50%.
What documentation supports G0104?
Document the screening purpose, the flexible sigmoidoscopy performed, its findings, and any intervention. If the procedure is diagnostic rather than screening, select the code that represents the diagnostic service.
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.
15,083G0101,,Ca screen;pelvic/breast exam,A,,0.44,0.68,,0.23,,0.07,1.19,0.74,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,084G0102,,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