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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 : 5.2.6.2 * Colonoscopies

5.2.6.2
Procedure code G0121 may be reimbursed once every ten years for clients who do not meet the criteria for high-risk as recommended by the American Cancer Society (ACS) and USPSTF. Procedure code G0121 must be submitted with one of the following diagnosis codes:
 
Procedure code G0105 may be reimbursed once every two years for clients who meet the definition of high-risk. Procedure code G0105 must be submitted with one of the following diagnosis codes:
 
Refer to:
Subsection 9.2.15.2, “Colorectal Cancer Screening” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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