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.
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