COLORECTAL CANCER SCREENING
Colorectal cancer (CRC) is a disease in which abnormal cell growth leads to tumor formation in the colon and/or rectum. It is the second leading cause of cancer-related death in the United States. CRC primarily affects men and women 50 years of age and older, and risks increase with age. If detected early, CRC may be treated and cured.
Depending on the CRC screening methodologies, colorectal screening tests may detect cancer, precancerous polyps, and other abnormalities in the colon and/or rectum. CRC usually starts as a polyp (a growth of tissue in the inner wall of the colon and/or rectum) with no symptoms. Polyps are thought to develop into cancer over a period of several years. Polyps identified through CRC screening can be removed before they develop into cancer. Therefore, in addition to identifying existing CRC, screening also helps prevent the disease. If diagnosed in its early stages, CRC is highly curable, with a survival rate of approximately 90%.
Retroactively effective to October 3, 2024, CMS updated the colorectal screening coverage to add Cologuard Plus™ as a preventive service.
Retroactively effective to April 1, 2025, CMS updated the colorectal cancer screening coverage to add Shield™ as a preventive service. Shield™ meets the CMS criteria for Blood-based Biomarker Tests outlined in National Coverage Determination (NCD 201.3) for Colorectal cancer Screening. Shield™ has an FDA market authorization with a colorectal cancer screening indication, has a sensitivity greater than or equal to 74%, and specificity greater than or equal to 90% in the detection of colorectal cancer compared to colonoscopy based on pivotal studies included in the FDA label and is performed in a Clinical Laboratory Improvement Act (CLIA)-certified laboratory.
ULTRASOUND SCREENING FOR ABDOMINAL AORTIC ANEURYSM (AAA)
Abdominal aortic aneurysm (AAA), which is an abnormal focal dilation of the abdominal aorta, is relatively common and has the potential for significant morbidity and mortality. Most individuals with AAA are asymptomatic but come to medical attention by findings of a pulsatile mass on physical examination, as the result of other abdominal imaging studies, or through ultrasound screening programs for AAA. When symptoms do occur, individuals commonly present with abdominal, back, or flank pain, but thromboembolism can also occur, leading to symptoms of limb ischemia. Aneurysms that produce symptoms are at an increased risk for rupture, which is associated with high mortality rates.
Retroactively effective to April 1, 2025, CMS updated the diagnosis codes (Z84.89 OR Z13.6 with any of the following Z87.891, F17.210, F17.211, F17.213, F17.218, F17.219) for Ultrasound Abdominal Aortic Aneurysm (AAA) Screening for Medicare Advantage members. 
