Effective July 1, UnitedHealthcare expanded preventive screening coverage for colon cancer to include fecal deoxyribonucleic acid (DNA) testing (example: Cologuard®).
The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer starting at age 50 and continuing until age 75. The risks and benefits of different screening methods vary. UnitedHealthcare recommends individuals discuss their screening options for colon cancer with their providers to determine which method best fits their needs.
UnitedHealthcare's Preventive Care Services Coverage Determination Guideline (CDG) has been updated to pay CPT code 81528 fecal DNA testing for colorectal cancer screening as preventive for age 50–75 years. This change applies to UnitedHealthcare fully insured and self-funded customers that follow UnitedHealthcare's standard preventive coverage.
In addition to adding coverage for fecal DNA, the July CDG also added a clarification that the codes for fecal immunochemical testing (FIT) are already included in UnitedHealthcare's Preventive Services benefit.
Note fecal DNA testing for colon cancer screening, which is paid as preventive once every three years, can be performed in lieu of a screening colonoscopy. If the fecal DNA test is positive, the health care provider may recommend that a screening colonoscopy be performed.
For additional information on Preventive Services changes, please review the grid of 2017 Preventive Services Notable CDG Updates or contact your UnitedHealthcare representative.