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Colorectal Cancer Awareness Month

Published on 

Wednesday, March 8, 2023

 | Coding 

Did You Know?

The U.S. Preventive Services Task Force’s indicated in their May 18, 2021 Final Recommendation statement for colorectal cancer screening that:

  • It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years,
  • Incidence of colorectal cancer (specifically adenocarcinoma) in adults aged 40 to 49 years has increased by almost 15% from 2000-2002 to 2014-2016,
  • In 2016, 25.6% of eligible adults in the US had never been screened for colorectal cancer, and
  • In 2018, 31.2% were not up to date with screening.

Based on these recommendations, this time last year I wrote that 45 was the new 50 for colorectal cancer screening.

Why it Matters?

Effective January 1, 2023, the recommended minimum age for certain colorectal screening tests has decreased from 50 to 45 years of age and older.

MLN Matters article MM13017, Removal of a National Coverage Determination and & Expansion of Coverage of Colorectal (CRC) Screening includes:

  • A list of the specific screening tests where the minimum age has decreased from 50 to 45 years and older, and  
  • An expanded definition of CRC screening tests and new billing instructions for colonoscopies under certain scenarios.

Also, National Coverage Determination (NCD 210.3) Colorectal Cancer Screening Tests has been revised to reflect the decrease in minimum age for each of the covered indications listed in this policy.

2023 Colorectal Cancer Screening Claims Being Held: Palmetto GBA, the Medicare Administrative Contractor for Jurisdictions J and M posted the following open claims issue regarding colorectal cancer screening claims:

“CMS has instructed Medicare Administrative Contractors to hold colorectal cancer screening claims with HCPCS codes G0104, G0105, G0106, G0120, G0121, G0327, G0328, 81528 and CPT® code 82270 until April 4, 2023. Claims for dates of service on or after January 1, 2023, will be held to allow the CMS system maintained to make updates to the claim processing system to accommodate 2023 colorectal cancer screening coverage changes.”

What Can You Do?

As a healthcare provider, be aware of the changes in Medicare’s colorectal screening coverage. The following changes have been made to the MLN Educational Tool Medicare Preventive Services

  • Information has been added about reduced coinsurance (starting January 1, 2023) when a screening colorectal cancer procedure becomes diagnostic or therapeutic,
  • The reduced minimum age for colorectal cancer screening tests from 50 to 45, and
  • If a non-invasive stool-based test returns a positive test, colorectal cancer screening tests now include a follow-up screening colonoscopy.  

As a healthcare consumer, I encourage everyone to talk with your doctor about your risk(s) for colorectal cancer and the need for screening tests.


U.S. Preventive Services Task Force May 18, 2021 Final Recommendation Statement for colorectal cancer screening:

MLN MM13017:

MLN Educational tool Medicare Preventive Services:

NCD 210.3 Colorectal Cancer Screening Tests:

Palmetto GBA Claims Payment Issue: 2023 Colorectal Cancer Screening Claims Being Held:

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.