Colorectal Cancer (Colon cancer)
Medicare covers one screening FOBT per year for beneficiaries ages 50 or older. The test must be ordered by the patient’s treating physician. Either a stool guaiac test or a FIT will be covered, but not both. Also, at least 11 months must have passed since the month of the patient’s last test.
Difference between screening and diagnostic colonoscopy
A screening test is a test provided to a patient in the absence of signs or symptoms. A screening colonoscopy is a service performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps.
Diagnostic colonoscopy is a test performed as a result of an abnormal finding, sign or symptom (such as abdominal pain, bleeding, diarrhea, etc.). Medicare and most payors do not waive the co-pay and deductible when the intent of the visit is to perform a diagnostic colonoscopy.
There are two Fecal Occult Blood Test (FOBT) tests:
| Immunoassay test | Chemical test | |
|---|---|---|
| FIT (Fecal Immunochemical Test) | FOBT (Fecal Occult Blood Test) | |
| Diagnostic code | 82274QW | 82272 |
| Screening code | G0328QW – Medicare
82274 – Commercial (Ages 50-75 years) |
82270
(Ages 50-75 years) |
| Examples | Hemosure – iFOB Test (FIT) | HenrySchein – OneStep Occult Blood |
| Reimbursement | ~$21 | ~$4 |
Routine screening examinations:
| ICD-10 Code | Description |
|---|---|
| Z12.10 | Encounter for screening for malignant neoplasm of intestinal tract, unspecified |
| Z12.11 | Encounter for screening for malignant neoplasm of colon |
| Z12.12 | Encounter for screening for malignant neoplasm of rectum |
Diagnostic examinations
When billing for FOBT that is being performed because the patient has symptoms of a medical condition, use the medical diagnosis code that corresponds to the patient’s symptoms.