Clarification for Coding Relating to Cologuard

CMS recently implemented a National Coverage Determination to cover Cologuard – a multitarget stool DNA test – as a colorectal cancer screening test for asymptomatic, average risk beneficiaries, aged 50 to 85 years. Previously, providers/suppliers used HCPCS code G0464 to bill for the Cologuard test. Per the 2016 Clinical Lab Fee Schedule Change Request 9465, effective December 31, 2015, HCPCS code G0464 expires. Beginning January 1, 2016, providers/suppliers should bill CPT code 81528 for the Cologuard test. Continue to use HCPCS code G0464 for claims with prior dates of service through December 31, 2015.

Source: https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2016-01-07-eNews.pdf