This bulletin applies to NC Medicaid Direct and NC Managed Care.
Background
ColoSense is a qualitative in vitro diagnostic test intended for the detection of colorectal neoplasia-associated RNA markers and the presence of occult hemoglobin in human stools. A positive ColoSense result may indicate the presence of colorectal cancer (CRC), advanced adenomas (AA), or serrated precancerous lesions (SPL) and should be followed by a colonoscopy.
ColoSense is indicated as a screening test for adults ages 45 and older who are at an average risk for developing CRC. It is not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high-risk individuals.
This update aligns with national colorectal cancer screening recommendations, aiming to improve early detection and prevention.
For information regarding the collection and transportation of laboratory specimens, please refer to policy 1S-3: Laboratory Services, located on the Program Specific Clinical Coverage Policies webpage.
Coverage Criteria
- Eligible Population: NC Medicaid beneficiaries, ages 45 and older.
- Frequency: Once every three years.
- Exclusions: ColoSense cannot be billed if the beneficiary has received Cologuard within the same three-year period.
Contact
NCTracks 1-800-688-6696