Colorectal Cancer Screening — Laboratory Reimbursement
Defines Blue Cross Blue Shield of New Mexico reimbursement stance for laboratory-based colorectal cancer screening tests and applicable coding; affects providers submitting claims for colorectal cancer screening for BCBSNM members.
Cologuard Plus™ was added as reimbursable once every 3 years.
Screening using cell-free DNA techniques (e.g., Guardant Shield™) was added as not reimbursable.
Procedure codes 0464U and 0537U were added to the code list.
Reimbursement Information #1 was revised to remove direct visualization tests (colonoscopy, CT, flexible sigmoidoscopy) from the screening list.
Coverage and Exclusions for Colorectal Cancer Screening
Coverage criteria and exclusions
Reimbursement policy for asymptomatic, average‑risk individuals and explicit exclusions:
ALL of the following
ALL of the following
- Individual is asymptomatic
- Individual is average risk
- Age is 45 to 75 years
ALL of the following
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.