Summary & Overview
HCPCS G0464: Stool-Based DNA and Fecal Occult Hemoglobin Colorectal Screening
HCPCS Level II code G0464 designates a stool-based colorectal cancer screening that combines stool DNA analysis with fecal occult hemoglobin testing (markers such as kras, ndrg4 and bmp3). As a noninvasive laboratory screening modality, this test supports early detection efforts for colorectal neoplasia and influences screening program design and preventive care coverage nationally. Payers evaluate coverage, frequency, and reimbursement for such multimarker stool tests within preventive screening benefit policies.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical purpose and service setting, typical payer approaches to coverage, and the policy and billing considerations that affect implementation at scale. The publication summarizes benchmark considerations, common billing and service-line contexts, and recent policy updates relevant to laboratory-based colorectal screening tests.
The content is intended to inform clinicians, billing staff, laboratory administrators, and policy analysts about the billing classification, typical use cases, and payer landscape for this stool-based colorectal cancer screening test. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G0464 describes a colorectal cancer screening test that uses stool-based DNA and fecal occult hemoglobin markers (for example, kras, ndrg4 and bmp3). This service is a noninvasive laboratory-based screening intended to detect molecular and hemoglobin markers associated with colorectal neoplasia.
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Service type: Stool-based colorectal cancer screening laboratory test
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Typical site of service: Clinical laboratory or outpatient laboratory setting
Clinical & Coding Specifications
Clinical Context
A 58-year-old average-risk adult receives an order from their primary care clinician for colorectal cancer screening using a stool-based DNA test that detects abnormal DNA markers (e.g., KRAS, NDRG4, BMP3) and fecal occult hemoglobin. The patient is mailed a collection kit from the outpatient laboratory or ambulatory clinical laboratory. The patient collects the specimen at home, returns the kit to the laboratory or a designated clinical collection site, and the laboratory performs the molecular and immunochemical analyses. The laboratory bills the technical component using G0464 with modifier TC when only the technical component is reported. Typical workflow steps include: clinician order entry, patient education and kit shipment, specimen receipt and accessioning at the laboratory, molecular and fecal hemoglobin testing, result reporting to the ordering clinician, and documentation of results in the electronic health record. Typical sites of service are outpatient clinics, physician offices that coordinate kit distribution, and independent or hospital outpatient laboratories that perform the test.
Coding Specifications
| Modifier | Description | When to Use |
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