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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 5 Ambulatory Surgical Center and Hospital Ambulatory Surgical Center : 5.2 Services, Benefits, Limitations, and Prior Authorization : 5.2.6 Colorectal Cancer Screening : 5.2.6.1 Sigmoidoscopies

5.2.6.1
Procedure code G0104 may be reimbursed once every 5 years and is limited to one of the following diagnosis codes:
 

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