Cutting-Edge Colorectal Cancer Screening Now Covered

CMS finalized the National Coverage Decision for Cologuard™, a colorectal screening test. People with Medicare who don't show symptoms of colorectal cancer will have access to the Cologuard multi-target stool DNA test, a first-of-its-kind test. It is being covered by Medicare through a pilot program run jointly by the Food and Drug Administration (FDA) and Medicare. Colorectal cancer is the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women. More than 90% of cases occur in people who are 50 years old or older. More men than women get colon cancer, and one or two out of every 100 men who are 60 today will develop colon cancer by age 70. In most cases, colorectal cancer develops from precancerous polyps (abnormal growths) in the colon or rectum. Cologuard™ studies a patient's stool sample to see if there's DNA code that suggests either the presence of precancerous polyps or colorectal cancer.

Medicare Part B covers the Cologuard™ test once every three years for people with Medicare who meet all of these conditions:

• Are between 50 and 85 years old
• Show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test, and
• Are at average risk of developing colorectal cancer
• Have no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn's Disease and ulcerative colitis; and
• Have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer

Source: AANP E-Bulletin