Subject to the terms and conditions of the applicable benefit contract, colorectal cancer screening is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in the medical policy are met.
Subject to the terms of the member's benefit contract, $0 cost share will be applied when colorectal cancer screening is performed as a preventive service at a participating provider, and there is direction from regulatory laws, such as the Affordable Care Act, to adjudicate the preventive service claim at $0 cost share.
This policy is consistent with applicable state mandates. The laws of the state where the group benefit contract is issued determine the mandated coverage.
US FOOD AND DRUG ADMINISTRATION STATUS
The US Food and Drug Administration (FDA) has approved several noninvasive colorectal screening tests (e.g., Cologuard™, Epi proColon™, fecal occult blood tests, and fecal immunochemical tests), for colorectal cancer screening.