Colorectal Cancer Screening
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Defines BCBSNM laboratory management reimbursement criteria for colorectal cancer screening tests and which screening modalities are reimbursable or excluded for asymptomatic individuals, affecting providers submitting claims to Blue Cross Blue Shield of New Mexico.
Added code 87626 and removed code 0500T in the 05/15/2026 update.
Previously (08/08/2025) reimbursement information was updated to add Cologuard Plus as reimbursable once every 3 years and to state cell-free DNA techniques (e.g., Guardant Shield) are not reimbursable.
Reimbursement Information unchanged in the 05/15/2026 update; document updated with literature review and minor code list changes.
Coverage Criteria for Colorectal Cancer Screening
Primary screening coverage
Covered when ALL of the following are met:
ALL of the following
ONE of
- Fecal immunochemical test (FIT) — preferred; may be reimbursable if performed annually.
- Guaiac fecal occult blood test (gFOBT); may be reimbursable if performed annually.
Policy applies to asymptomatic, average-risk individuals; providers should confirm member eligibility and plan/contract terms.
FIT-DNA coverage
Covered when ALL of the following are met:
Non-reimbursable tests
The following screening tests or techniques are not reimbursable for average-risk asymptomatic screening:
ONE of
- Methylated Septin 9 (ColoVantage) — not reimbursable.
- Screening for anal cytologic abnormalities (anal pap smear) — not reimbursable.
- Screening for anal HPV infection — not reimbursable.
- Screening using cell-free DNA techniques (e.g., Guardant Shield) — not reimbursable.
Inclusion of a procedure code in the code list does not by itself guarantee coverage or reimbursement eligibility; see Procedure Codes section for examples of codes referenced in this policy.
Age-based exclusion
Screening is not reimbursable when the following age-based condition is met:
For average-risk asymptomatic individuals over 75 years of age, colorectal cancer screening is not reimbursable.
Procedure Codes and Frequency
| 81327 | SEPT9 GEN PRMTR MTHYLTN ALYS |
| 81528 | ONCOLOGY COLORECTAL SCR |
| 82270 | OCCULT BLOOD FECES |
| 82274 | ASSAY TEST FOR BLOOD FECAL |
| 87624 | HPV HI-RISK TYP POOLED RSLT |
| 87625 | HPV TYPES 16 & 18 ONLY |
| 87626 | HPV SEP HI-RSK TYP&POOL RSLT |
| 88112 | CYTOPATH CELL ENHANCE TECH |
| 0464U | ONC CLRCT SCR QRTSA DNA MRK |
| 0537U | ONC CLRCT CA CFDNA >2500 DMR |
Claims Documentation and Billing Requirements
Claims documentation and coding requirement
Providers must submit accurate documentation of services performed and use valid HIPAA-approved code combinations when filing claims; claims are subject to code edit protocols, claim review, and applicable plan/contract terms. Upon request, providers should be prepared to submit any additional documentation to support the claim.
- Submit claims using valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD-10, etc.).
- Ensure coding follows industry standard guidelines (Uniform Billing, AMA CPT guidance, CMS NCCI edits and policy manual).
- Be prepared to provide additional documentation upon request for claim review and code edit resolution.
Test Definitions and Notes
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