Coverage Requirements

Related Topics

Footnotes

  1. Because all plan and benefit designs are different, and the rules differ if a provider is out-of-network, patients and providers are encouraged to ask their individual insurers about coverage.
  2. Exact Sciences estimate based on recent historical patient billing. Rate of coverage varies by state and region. Exceptions for coverage may apply. Only the patient's insurer can confirm how the Cologuard® test would be covered.
  3. Some exceptions may apply, so it is recommended that patients call their insurer to confirm.

List of definitions

ACA: Affordable Care Act; CMS: Centers for Medicare & Medicaid Services; CRC: colorectal cancer; mt-sDNA: multitarget stool DNA; SBT: stool-based test.


References

  1. US Department of Labor. FAQs about Affordable Care Act implementation part 51, Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation. Updated January 10, 2022. Accessed January 23, 2024. https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf
  2. Centers for Medicare & Medicaid Services. HHS finalizes physician payment rule strengthening access to behavioral health service and whole-person care. January 3, 2024. Accessed January 29,2024. https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-access-behavioral-health-services-and-whole
  3. Centers for Medicare & Medicaid Services. National Coverage Determination-Colorectal Screening tests. November 1, 2022. Accessed January 23, 2024. https://www.cms.gov/medicare-coverage-database/view/ncd.aspx
  4. Data on File. Exact Sciences Corporation. Madison, WI.
  5. Exact Sciences. Cologuard® Helps More People Get Screened In A Cost-Effective Way. September 10, 2019. Accessed April 23, 2024. https://www.exactsciences.com/newsroom/press-releases/cologuard-helps-more-people-get-screened-in-a-cost-effective-way
  6. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965-1977.
  7. Hitchcock ME, Green BB, Anderson DS. Advancing health equity for Medicaid beneficiaries by adding colorectal cancer screening to the Centers for Medicare and Medicaid Services Adult Core Set. Gastroenterology. 2022;162(3):710-714.