Medicare Part B covers eligible multi-target stool DNA screening, the category associated with Cologuard, when its requirements are met. A brand name or mailed kit alone does not establish that a test is appropriate or covered for you.
Check all screening requirements
| Requirement | Medicare rule |
|---|---|
| Age | 45 through 85. |
| Symptoms | No signs or symptoms of colorectal disease. |
| Risk | Average risk under Medicare's history criteria. |
| Frequency | Generally once every three years. |
Average risk excludes specified personal and family histories. Tell the ordering professional about prior polyps, colorectal cancer, inflammatory bowel disease and relevant family history. Do not choose a screening category simply because it appears to have no cost.
Screening is different from investigating symptoms
If you have symptoms or an earlier abnormal finding, your clinician may need a diagnostic evaluation instead. The clinical reason determines the appropriate service and coverage pathway. This article does not recommend one screening method over another.
Costs and a positive result
For the covered stool DNA screening, you pay nothing when the provider accepts assignment. Medicare also treats a follow-up colonoscopy after a positive covered stool DNA test as a screening service.
Confirm how any additional services would be billed. A screening benefit is not a promise that every unrelated test or office service will have no charge.
Before returning a kit
- Confirm the order and exact test with the practice.
- Check when you last had the covered screening.
- Verify the laboratory and your coverage.
- Ask how results and follow-up will be communicated.
Medicare Advantage members should use the plan's approved arrangements. For a denial, obtain the reason and review eligibility, timing and billing with the provider before appealing.
Related coverage questions
- Medicare Colonoscopy Coverage: Screening, Frequency and Costs
- Blood Work and Medicare: Diagnostic Tests, Screening and Costs
- A Medicare Medical Claim Was Denied: What to Do Next