The purpose of this Transmittal is to provide notice of coverage and reimbursement for the at-home screening for colon cancer using a laboratory test that looks for genetic abnormalities which increase colon cancer risk. The test is commonly referred to as CologuardĀ® and is reported using billing code 81528 (oncology colorectal scr) in the professional fee schedule. It is covered by Medicaid once every three years. The reimbursement rate for this laboratory test is based on the published guidance by CMS and in accordance with the District of Columbia payment policy. This is applicable for fee-for-service providers that bill procedure codes on CMS-1500 claim forms and for providers enrolled in Medicaid Managed Care Organization (MCO) networks.
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