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CMS Implements Expansion of CRC Screening Coverage
The Centers for Medicare & Medicaid Services announced that as of February 27, both agencies have reduced the minimum age for coverage for of several colorectal cancer (CRC) screening tests from 50 years to 45 years.
These tests include:
• screening flexible sigmoidoscopy test
• screening Cologuard multi-target stool DNA (sDNA) test
• screening guaiac-based fecal occult blood test (gFOBT)
• screening immunoassay-based fecal occult blood test (iFOBT)
• screening barium enema test
• screening blood-based biomarker tests
In addition, a colonoscopy following a positive result from a noninvasive stool-based CRC screening test will no longer classified as a diagnostic colonoscopy. “We now understand both the non-invasive, stool-based test and the follow-on colonoscopy are both part of a continuum of a complete CRC screening,” according to the CMS statement. “Patient cost sharing won’t apply to the non-invasive, stool-based test and the follow-on screening colonoscopy in this scenario, because both are specified preventive screening services.”
Frequency limitations for screening colonoscopies in described in 42 CFR 410.37(g) also will not apply to follow-on a screening colonoscopy subsequent to a positive result from a stool-based test, “to remove barriers and encourage the patient to proceed to the colonoscopy procedure soon after the positive result from the stool-based test.”
CMS stressed that to ensure that the follow-up screening colonoscopy is covered under these new guidelines, providers must attach the KX modifier to a screening colonoscopy code when billing under Medicare or Medicaid for these tests.
--Rebecca Mashaw
Reference:
Removal of a national coverage determination & expansion of coverage of colorectal cancer screening. MLN Matters Number: MM13017 Revised. February 16, 2023.
Accessed March 6, 2023.
