Colorectal Cancer Screening

60 - Colorectal Cancer Screening (Rev. 10818; Issued: 05-20-21; Effective: 01-09-21; Implementation: 10-04-21) See the Medicare Benefit Policy Manual, Chapter 15, and the Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Section 210.3 for Medicare Part B coverage requirements and effective dates of colorectal cancer screening services. Effective for services furnished on or after January 1, 1998, payment may be made for colorectal cancer screening for the early detection of cancer. For screening colonoscopy services (one of the types of services included in this benefit) prior to July 2001, coverage was limited to high-risk individuals. For services July 1, 2001, and later, screening colonoscopies are covered for individuals not at high risk. The following services are considered colorectal cancer screening services: • Fecal-occult blood test (FOBT),1-3 simultaneous determinations (guaiac-based); • Flexible sigmoidoscopy; • Colonoscopy; and, • Barium enema Effective for services on or after January 1, 2004, payment may be made for the following colorectal cancer screening service as an alternative for the guaiac-based FOBT, 1-3 simultaneous determinations: • FOBT, immunoassay, 1-3 simultaneous determinations Effective for services on or after October 9, 2014, payment may be made for colorectal cancer screening using the Cologuard™ multi-target sDNA test: • HCPCS G0464 (Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., KRAS, NDRG4 and BMP3). Note: HCPCS code G0464 expired on December 31, 2015, and has been replaced in the 2016 CLFS with CPT code 81528, Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result, effective January 2, 2016. Effective for services on or after January 19, 2021, payment may be made for colorectal cancer using Blood-based DNA Testing: • Blood-based Biomarker Test, HCPCS G0327, effective July 1, 2021