2023 | How To Use HCPCS G0101 & HCPCS G0102

HCPCS code G0101 & HCPCS code G0102 are used to screen vaginal and prostate cancer. The description and coding guidelines for G0101 & G0102 can be found below.

HCPCS Code G0101

Description of G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination.

Coding Guidelines For G0101: Under certain circumstances, G0101 may be reported with evaluation and management (E&M) services. 

If a Medicare-covered reasonable and medically necessary E&M service requires breast and pelvic examination, G0101 should not be additionally reported.  However, suppose the Medicare-covered reasonable and medically necessary E&M service and the screening service, G0101, are unrelated. In that case, HCPCS code G0101 and the E&M service may be reported appending modifier 25 to the E&M service CPT code. 

The use of modifier 25 indicates that the E&M service is significant and separately identifiable from the screening service, G0101.

HCPCS Code G0102

Description of G0102: Prostate cancer screening; digital rectal examination.

Coding Guidelines For G0102: G0102 is not separately payable with an evaluation and management code (CPT codes 99201-99499). CMS published this policy in the Federal Register as follows:

“As stated in the July 1999 proposed rule, a digital rectal exam (DRE) is a quick and simple examination taking only a few seconds.  We believe it is rarely the sole reason for a physician encounter and is usually part of an E/M encounter.  When it is the only service furnished or furnished as part of an otherwise non-covered service, we will pay separately for code G0102.  When it is furnished on the same day as a covered E/M service, we believe bundling it into the payment for the covered E/M encounter is appropriate.”