Reminder: BCN covers Cologuard tests only for members age 50 or older

As a reminder, BCN covers the fecal DNA analysis known as Cologuard® only for members who meet the criteria outlined in the medical policy titled Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening. (PDF)

This applies to BCN commercial and BCN Advantage members.

According to the medical policy, Cologuard tests are eligible for coverage only for members who:

  • Are between 50 and 75 years of age

    Note: The U.S. Preventive Services Task Force recommends colon and rectal screening for patients 50 through 75 years of age. Screening in patients above age 75 should be an individualized decision made in consultation with an attending physician or other qualified health professional.

  • Are at average risk for colorectal cancer
  • Are asymptomatic (have no signs or symptoms of colorectal disease, including but not limited to lower gastrointestinal pain, blood in the stools, positive fecal occult blood test or fecal immunochemical test)
  • Have not had a Cologuard test in the prior three years

We're publishing this information because we've recently received claims from providers for Cologuard tests for members under age 50. Those claims were denied.

You can access this medical policy as follows:

  1. Visit bcbsm.com/providers.
  2. Scroll down and click Quick Links.
  3. Click Out-of-state providers.
  4. Click Medical policy, precertification and preauthorization router.
  5. Click Medical Policies.
  6. In the Policy / Topic Keyword field, type "fecal DNA."
  7. Click the search icon.
  8. Click to open the Medical Policy - Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening document.

Posted: December 2020
Line of business: Blue Care Network