CMS Pub. 100-04, ch. 18, § 60.5

The following non-covered HCPCS codes are used to allow claims to be billed and denied for

beneficiaries who need a Medicare denial for other insurance purposes for the dates of service

indicated:

A. From January 1, 1998, through June 30, 2001, Inclusive

Code G0121 (colorectal cancer; colonoscopy on an individual not meeting criteria for high risk)

should be used when this procedure is performed on a beneficiary who does not meet the criteria

for high risk. This service should be denied as non-covered because it fails to meet the

requirements of the benefit for these dates of service. The beneficiary is liable for payment. Note

that this code is a covered service for dates of service on or after July 1, 2001.

B. On or After January 1, 1998

Code G0122 (colorectal cancer; barium enema) should be used when a screening barium enema is

performed not as an alternative to either a screening colonoscopy (code G0105) or a screening

flexible sigmoidoscopy (code G0104). This service should be denied as non-covered because it

fails to meet the requirements of the benefit. The beneficiary is liable for payment.