G0121 Colon ca scrn not hi rsk indColorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
Status A: active, paid separately under the PFS if covered. Global period 000. Qualifying APM participants are paid at a $33.5675 conversion factor.
2 of 2 payer prior-auth lists that name G0121 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth required | site of care: site of service reviewed | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth under conditions | site of care: outpatient hospital | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 |
G0121 appears in 10 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Centene, Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Colonoscopy, Colorectal Cancer Screening, and Related Procedures (0516) | covered if criteria are met | Aug 20, 2026 | payer document |
| Aetna | In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (0783) | listed, no stance | Dec 11, 2025 | payer document |
| Aetna | Virtual Gastrointestinal Endoscopy (0535) | listed, no stance | Jul 30, 2026 | payer document |
| Anthem | Colonoscopy (CG-SURG-01) | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Colonoscopy Flexible Sigmoidoscopy And Ct Colonography (L.2.04.403) | covered if criteria are met | payer document | |
| Centene | Anesthesiology Services for Gastrointestinal Endoscopy (CP.MP.161) | covered if criteria are met | May 1, 2019 | payer document |
| Premera Blue Cross | Preventive Care | covered if criteria are met | Sep 21, 2026 | payer document |
| Regence | Surgical Site of Care – Colonoscopy and Sigmoidoscopy (Utilization Management 20) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Preventive Care Services (MP.016.59) USPSTF Rating (May 2021): B | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Screening Colonoscopy Procedures – Site of Service (MP.15.14) | listed, no stance | Jul 1, 2026 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.