CodeMap® 
150 North Wacker Drive
Suite 2360
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule

2023
2022

Physician Fee Schedule

2023
2022

OPPS Fee Schedule

2023-October
2023-July

ASC Fee Schedule

2023-October
2023-July

APC Codes

2023-October
2023-July

DRG Codes

2023
2022

ASP Drug Pricing Files

October 2023
July 2023


CMS Transmittals



National Coverage Determination
Procedure Code: 8XXXX
Multitarget Stool DNA (sDNA) Colorectal Cancer Screening Test - Cologuard
CMS Policy Number: 210.3
Back to NCD List

Frequency Limitations: Effective for dates of service on or after October 9, 2014, colorectal cancer screening using the CologuardTM multitarget sDNA test (G0464) is covered once every 3 years for Medicare beneficiaries that meet all of the following criteria:

• Ages 50 to 85 years,
• Asymptomatic (no signs or symptoms of colorectal disease including but not limited to lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test), and,
• At average risk of developing colorectal cancer (no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis; no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer).

Effective for claims with dates of service on or after October 9, 2014, providers shall report the following diagnosis codes when submitting claims for the CologuardTM multitarget sDNA test:

ICD-9: V76.41 and V76.51, or,

ICD-10: Z12.11 and Z12.12



To review all requirements of this policy, please see: CMS NCD listing by Chapter

This policy includes primary and secondary diagnosis code requirements. Please review all requirements of this policy.

.... and many more.


Sorry, you need to login or register to view additional sections of this Medicare policy.

Click here for publications catalog.
--

The content and format of the following files and/or webpages are copywritten and the property of Wheaton Partners, LLC - dba CodeMap®. All recipients of these files agree not to distribute, reproduce and/or use the information contained within, in any manner not expressly agreed upon by the user and Wheaton Partners, LLC - dba CodeMap®.

All code-pairs and Medicare coverage information are compiled directly from Center for Medicare and Medicaid Services (CMS) and Medicare Contractor coverage policies. CodeMap® has made every reasonable effort to ensure the accuracy of the information contained. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. Both CMS and Medicare contractor coverage policy information may change at any time. CodeMap® makes no representation, warranty, or guarantee that this compilation of coverage policy information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.


CodeMap® is a Registered Trademark of Wheaton Partners, LLC.