Question:
What are the Medicare coverage requirements for code 81528, the stool-based DNA colorectal cancer screening test, including the eligible age range, screening frequency, and patient risk criteria?
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
