To do the test:
Occult blood in the stool may indicate colon cancer or polyps in the colon or rectum - though not all cancers or polyps bleed. Typically, occult blood is passed in such small amounts that it can be detected only through the chemicals used in a fecal occult blood test.
– Occult blood in the stool may indicate colon cancer or polyps in the colon or rectum, though not all cancers or polyps bleed. – Your test could show a positive result when you have no cancer (false-positive result) if you have bleeding from other sources, such as a stomach ulcer, hemorrhoid, or even blood swallowed from your mouth or your nose.
They include:
Medicare covers screening fecal occult blood tests once every 12 months, if you get a referral from your doctor, physician assistant, nurse practitioner or clinical nurse specialist. If you're 50 or older, Medicare covers this lab test once every 12 months. If you're under 50, Medicare doesn't cover this test.
5.
Medicare recognizes the two iFOBT codes based on whether the physician orders the test for colorectal cancer screening (G0328) or for a diagnostic purpose (82274).
Medicare will pay for a covered FOBT (either 82270* (G0107*) or G0328, but not both) at a frequency of once every 12 months (i.e., at least 11 months have passed following the month in which the last covered screening FOBT was performed).
Medicare will cover the new colorectal cancer screening FOBT G0328 beginning January 1, 2004. G0328 is payable under the clinical lab fee schedule. Medicare patients aged 50 and over can only receive one FOBT per year, either G0107 (gFOBT, or guaiac-based) or G0328 (iFOBT, or immunoassay-based).
CPT code 82270 specifically states that it is used for “colorectal neoplasm screening”; 82272 is used for purposes “other than colorectal neoplasm screening.” Medicare requires code G0328 for a fecal hemoglobin determination by immunoassay when the service is performed for colorectal cancer screening rather than ...
a. Screening CT colonography (74263) will be denied as non-covered.
Z12. 11: Encounter for screening for malignant neoplasm of the colon.
Calprotectin - Faeces Medicare does not cover any of the costs of testing.
FIT Test CPT Code: 82274—blood, occult by fecal hemoglobin determination by immunoassay, qualitative, feces, 103 simultaneous determinations.
HCPCS G0122 – Colorectal cancer screening; barium enema (noncovered). (CPT code 82270) is $4.54.
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.
Frequency Limitations: Screening fecal occult blood tests are covered at a frequency of once every 12 months for beneficiaries who have attained age 50. A written order from the beneficiary’s attending physician is required.
A health care provider gives a fecal occult blood test card to the beneficiary, who takes it home and places stool samples on it. The beneficiary either returns the card with the stool samples to the health care provider or to a laboratory for testing.
Medicare covers some screening procedures. When services are provided for screening purposes, it is important to submit these services with the correct CPT or HCPCS code. Fecal Occult Blood Tests (FOBTs) may be covered for both screening and diagnostic purposes. A diagnostic FOBT is one performed based on signs and/or symptoms exhibited by ...
Diagnostic FOBT. Medicare may also cover a diagnostic FOBT when the procedure is medically necessary. Coverage for diagnostic (non-screening) FOBTs is based on a CMS National Coverage Determination (NCD): ‘Fecal Occult Blood Test external link. 1 ICD-9 Codes are associated with CPT code 82270 in this policy.