Medicaid SC – Coverage of MT-sDNA Test (Cologuard®) for Colorectal Screening

The South Carolina Department of Health and Human Services (SCDHHS) will add the multitargeted stool DNA (MT-sDNA) test, also known as Cologuard®, in the covered preventive screenings beginning July 1, 2023. This change aligns with the United States Preventive Services Task Force (USPSTF) recommendation for colorectal screening. This coverage applies to fullbenefit Healthy Connections Medicaid members and those enrolled in the Family Planning limited benefit program.

Reimbursement Rate and Code The test should be billed by using CPT code 81528. Reimbursement for this screening for Healthy Connections Medicaid members enrolled in the fee-for-service Medicaid program will be $396.92.

Source: https://image.messages.scdhhs.gov/lib/fe2911747364047d7d1279/m/1/2103e8cb-0a58-4af0-b99e-64a7e503276f.pdf