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Female Rectal Exams

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Up until the past few weeks, I have been able to bill for a G0102 (rectal exam) for patients of either sex. However, I’ve started getting denials from Medicare. Is there a different CPT I should be using for a rectal exam on a woman? Many of these exams are associated with a yearly exam for female patients. However, some are for presenting signs and symptoms.

Question: Up until the past few weeks, I have been able to bill for a G0102 (rectal exam) for patients of either sex. However, I’ve started getting denials from Medicare. Is there a different CPT I should be using for a rectal exam on a woman? Many of these exams are associated with a yearly exam for female patients. However, some are for presenting signs and symptoms.

Answer: As far as I’m aware and can discover, Medicare and most other payers cover a digital rectal exam (DRE) for men only as part of a screening for prostate disease. Medicare will cover a DRE for men over 50 on Medicare once every 12 months and also will cover a PSA test every 12 months.

If you are doing DREs to check for colon cancer, you need to use other procedures. Medicare covers a fecal occult blood test every 12 months, a flex sig every 48 months, and a screening colonoscopy once every 24 months if the patient is at high risk, or once every 10 years but not within 48 months of a screening sig if the patient is not at high risk.

I generally find it easiest to go to the Medicare site for patients to check on benefits.

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