Blood-based biomarker tests (screening) for colorectal cancer
Medicare Part B (Medical Insurance) covers blood-based biomarker screening tests to check for colorectal cancer
Description
Blood-based biomarker tests can help detect colorectal cancer early, when treatment is most effective.
Coverage details
Medicare covers a blood-based biomarker screening test to check for colorectal cancer if you meet all these conditions:
- You’re between 45–85.
- You show no symptoms of colorectal disease (including, but not limited to, lower gastrointestinal pain, blood in stool, or positive guaiac fecal occult blood test or fecal immunochemical test).
- You're at average risk for developing colorectal cancer, meaning:
- 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.
If you get a positive result after a blood-based biomarker screening test, Medicare also covers a follow-up colonoscopy as a screening test.
Costs
You pay nothing for this test if your doctor or other health care provider accepts assignment .
How often
Medicare covers a blood-based biomarker screening test for colorectal cancer (if available) once every 3 years.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service