Does Medicare cover Cologuard (stool DNA tests)?

What is a multitarget stool DNA test?

A multitarget stool DNA test (sDNA-FIT) is a stool test for colorectal cancer screening that, according to the National Cancer Institute, detects hemoglobin along with certain DNA biomarkers from cells shed from the lining of the colon and rectum. Medicare.gov describes multitarget stool DNA screening tests as tests that check for genetic changes in a sample of your stool to look for signs of cancer in the colon or rectum, and Medicare Part B covers them as an at-home test if you're eligible.

Who qualifies for a Medicare-covered stool DNA test?

Medicare Part B covers a multitarget stool DNA test only if you meet all of these conditions:

• You're between 45 and 85.
• You show no symptoms of colorectal disease, including but not limited to lower gastrointestinal pain, blood in your stool, or a positive guaiac fecal occult blood test or fecal immunochemical test.
• You have no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease (including Crohn's disease and ulcerative colitis).
• You have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

How often does Medicare cover a stool DNA test?

Medicare Part B covers a multitarget stool DNA screening test every 3 years if you meet the conditions above.

What do I pay for a stool DNA test and any follow-up?

You pay nothing for a multitarget stool DNA test if your doctor or other health care provider accepts assignment, which means the provider agrees to accept the payment amount Medicare approves for the service and not to bill you for more than the Medicare deductible and coinsurance.

If you get a positive result, Medicare Part B also covers a follow-up colonoscopy as a screening test, and you pay nothing for that screening if your provider accepts assignment. If your provider finds and removes a polyp or other tissue during the colonoscopy, you pay 15% of the Medicare-approved amount for your provider's services, plus a 15% coinsurance to the facility in a hospital outpatient setting or ambulatory surgical center; the Part B deductible doesn't apply. See what Medicare pays for colonoscopies.

What other colorectal cancer screenings does Medicare cover?

Medicare Part B also covers other colorectal cancer screening tests, each with its own rules:

• Screening colonoscopy: no minimum age; once every 24 months if you're at high risk for colorectal cancer, or once every 120 months (48 months after a previous flexible sigmoidoscopy) if you aren't.
• Fecal occult blood test: once every 12 months if you're 45 or older, with a referral from your doctor, physician assistant, nurse practitioner or clinical nurse specialist.
• Blood-based biomarker test: once every 3 years (if available) if you're 45 to 85, have no symptoms of colorectal disease and are at average risk.