Laboratory Question for the Week of October 23, 2023

Question:

When is code 81528 covered by Medicare?

Answer:

Code 81528 was added in 2016 for stool-based DNA colorectal cancer screening. Medicare Part B covers this molecular pathology procedure once every 3 years for beneficiaries meeting all of the following:

• Between 50 and 85 years old through December 31, 2022, and beginning January 1, 2023, for those aged 45-85 years
• 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
• 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

This question was answered in our Coding Essentials for Laboratories. For more hot topics relating to laboratory services, please visit our store or call us at 1.800.252.1578, ext. 2.