CMS Lowers Age to Start Covering Most CRC Screening Tests
Medicare to Implement Various CRC Screening Coverage Changes Feb. 27
Feb. 21, 2023, News Staff — With the start of Colorectal Cancer Screening Awareness Month just a week away, CMS has announced several changes to its coverage for colorectal cancer screening tests under Medicare Part B. According to a recent MLN Matters® article from the Medicare Learning Network, the changes are intended to remove barriers to CRC screening.
First, the agency is reducing the minimum age at which coverage for the following CRC screening tests begins from age 50 years to age 45 or older:
- flexible sigmoidoscopy (Healthcare Common Procedure Coding System code G0104)
- guaiac-based fecal occult blood test (CPT code 82270)
- immunoassay-based fecal occult blood test (HCPCS code G0328)
- Cologuard™ multi-target stool DNA test (CPT code 81528)
- barium enema test (HCPCS codes G0106 [when administered as an alternative to screening sigmoidoscopy] and G0120 [when administered as an alternative to screening colonoscopy])
- blood-based biomarker test (HCPCS code G0327)
Screening colonoscopy continues to have no minimum age limitation. No modifications to existing maximum age limitations (where applicable) have been made for CRC screening tests.
CMS also said a positive result from a noninvasive stool-based CRC screening test no longer requires that the follow-up colonoscopy be a diagnostic colonoscopy. Covered CRC screening tests now include a follow-on screening colonoscopy after a Medicare-covered, noninvasive stool-based CRC screening test returns a positive result.
“We now understand both the noninvasive stool-based test and the follow-on colonoscopy are part of a continuum of a complete CRC screening,” the agency said in its announcement. “Patient cost-sharing won’t apply to the noninvasive stool-based test and the follow-on screening colonoscopy in this scenario because both are specified preventive screening services.”
In addition, current statutory limitations on screening colonoscopy frequency won’t apply to the screening colonoscopy that follows a positive result from a stool-based test. Physicians should attach the KX modifier to a screening colonoscopy code to indicate the service was performed as a follow-on screening after a positive result from a stool-based test.
“Our policy goal of not having frequency limitations to the follow-on screening colonoscopy after a noninvasive stool-based test returns a positive result is to remove barriers and encourage the patient to proceed to the colonoscopy procedure soon after the positive result from the stool-based test,” the CMS announcement concluded.