What changed?

Medicare Part B can cover qualifying non-invasive biomarker colorectal cancer screening tests once every three years when all applicable patient, ordering, and test requirements are met. These tests look for molecular markers associated with colorectal cancer or precancerous changes using blood, bodily secretions, or material from the intestinal tract.

Who may qualify?

Under the national policy, the beneficiary generally must:

  • Be between ages 45 and 85.
  • Have no signs or symptoms of colorectal disease.
  • Be at average risk for colorectal cancer.
  • Receive information about the test’s performance and the importance of a follow-up colonoscopy after a positive result.

The test must also be ordered by an eligible healthcare professional who will use the result in managing the patient’s care. In addition, the test itself must satisfy Medicare’s FDA authorization, laboratory, and performance requirements.

What should beneficiaries know?

Coverage does not mean every non-invasive test will automatically qualify. Ask your healthcare professional which colorectal cancer screening option is appropriate for you and confirm that the specific test meets Medicare’s requirements. If a screening result is positive, timely follow-up with your healthcare professional is important.

The Medicare Minute takeaway: This policy gives eligible Medicare beneficiaries another potential screening option. Your age, symptoms, risk level, ordering provider, and the specific test all matter when determining coverage.
Educational information only. This article summarizes public Medicare information and is not medical advice or a complete description of benefits. Eligibility, coverage, provider rules and costs can vary by individual circumstances and specific plan.