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Medical Mutual of OhioMedicare Advantage · Billing Codes · Coding · Gastroenterology, General Surgery, Family Medicine +1 moreHigh impact

Coding Follow-Up Colonoscopies Correctly for Medicare Advantage Members

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Medicare Advantage members must have follow-up colonoscopies after positive stool-based tests coded as screening (G0105/G0121) with modifier KX to ensure $0 member cost-sharing. If biopsy/polypectomy is performed during the same visit, append modifier PT to the therapeutic CPT code as secondary.

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What to do

immediately · 3 steps
01Billing team must update coding workflows to use G0105 or G0121 with modifier KX for follow-up colonoscopies after positive stool tests for Medicare Advantage members.
02When biopsy/polypectomy occurs during screening colonoscopy, append modifier PT to the therapeutic CPT code (not the G-codes).
03Update billing system edits and train staff on proper modifier usage to prevent inappropriate member cost-sharing.

Codes mentioned

G0105G012145385

Original notice

Coding Follow-Up Colonoscopies Correctly for Medicare Advantage Members
medmutual.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Medical Mutual of Ohio policiesGastroenterologyGeneral SurgeryFamily MedicineInternal MedicineCode G0105Code G0121Code 45385

Summaries are AI-assisted. Always confirm against the original payer notice.

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