Screening for Colorectal Cancer - Blood-Based Biomarker Tests
Governs coverage of blood-based biomarker laboratory tests used to screen for colorectal cancer for Medicare beneficiaries and HealthPartners enrollees when applicable coverage requirements are met.
CMS determined evidence is sufficient to cover a blood-based biomarker test as an appropriate colorectal cancer screening test once every 3 years for Medicare beneficiaries when performed in a CLIA-certified laboratory and ordered by a treating physician.
Coverage for the Epi proColon test is not supported; CMS will non-cover the Epi proColon test based on current evidence.
Coverage Criteria for Blood-based Colorectal Cancer Screening
Covered with criteria
Covered when ALL of the following are met:
Per CMS final decision memo
The currently available Epi proColon® test does not meet the policy's coverage criteria and is non‑covered. CMS reviewed the evidence and determined the Epi proColon® test does not qualify as an appropriate blood‑based biomarker colorectal cancer screening test; accordingly, it is excluded from coverage under this policy.
Based on current evidence and CMS's final decision memo, the Epi proColon® test is explicitly classified as non‑covered for colorectal cancer screening. Providers should not bill or expect coverage for this test under the blood‑based biomarker screening benefit.
Coding and Screening Interval
| H2462 | code listed in policy header |
| H3416 | code listed in policy header |
| H2422 | code listed in policy header |
| H4882 | code listed in policy header |
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