G9998 HCPCS - DOCUMENTATION OF MEDICAL REASON(S) FOR AN INTERVAL OF LESS THAN 3 YEARS SINCE THE LAST COLONOSCOPY (E.G., LAST COLONOSCOPY INCOMPLETE, LAST COLONOSCOPY HAD INADEQUATE PREP, PIECEMEAL REMOVAL OF ADENOMAS, OR SESSILE SERRATED POLYPS >= 20 MM IN SIZE, LAST COLONOSCOPY FOUND GREATER THAN 10 ADENOMAS, LOWER GASTROINTESTINAL BLEEDING, OR PATIENT AT HIGH RISK FOR COLON CANCER DUE TO UNDERLYING MEDICAL HISTORY ([I.E. CROHN'S DISEASE, ULCERATIVE COLITIS, PERSONAL OR FAMILY HISTORY OF COLON CANCER, HEREDITARY COLORECTAL CANCER SYNDROMES])

Code Information

HCPCS Code: G9998
Sequence Number: 0010
Short Description: Doc med rsn <3 colon
Long Description: Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])
Date Added: 1/1/2022
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2024
Classification: Temporary Procedures & Professional Services
Coding System: HCPCS

Berenson-Eggers Type Of Service Code: Z2 - Undefined codes
Type Of Service Code:
- 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96

Pricing Indicator Code:
- 00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
Multiple Pricing Indicator Code: 9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
Coverage Issues Manual Reference Section Number:
N/A
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: C - Carrier judgment

Field Name	Field Value
Healthcare Common Procedure Coding System Code	G9998
HCPCS Sequence Number	0010
HCPCS Record Identification Code	3 - First line of procedure record also contains detail information in positions 92-275
HCPCS Long Description	Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])
HCPCS Short Description	Doc med rsn <3 colon
HCPCS Pricing Indicator Code 1	00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
HCPCS Multiple Pricing Indicator Code	9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
HCPCS Coverage Code	C - Carrier judgment
HCPCS Berenson-Eggers Type Of Service Code	Z2 - Undefined codes
HCPCS Type Of Service Code 1	1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	1/1/2022
HCPCS Action Effective Date	1/1/2024
HCPCS Action Code	N - No maintenance for this code