Effective Jan. 1, 2023, the minimum age was adjusted from 50 years to 45 years for Cologuard (multi-target stool DNA-based colorectal screening). Cologuard is approved for male or female beneficiaries with an average risk of colorectal cancer once every three years. Cologuard is not intended to replace diagnostic colonoscopy in high-risk beneficiaries.
Contraindications include the following:
- Family or personal history of colorectal cancer
- Previous positive test from another colorectal screening test within the last six months
- Conditions associated with high risk:
a. Inflammatory Bowel Disease
b. Crohn’s disease
c. Chronic Ulcerative Colitis
d. History of Polyps
f. Relevant familiar (heredity) cancer syndrome such as Lynch syndrome
Please resubmit claims that were billed after Jan. 1, 2023, that denied because the beneficiary was ages 45-49.
NC Medicaid Contact Center; 888-245-0179