Who should get it: Age 45 to 75*
- Description: Screening for colon / colorectal cancer in adults age 45 to 75. *Effective no later than April 1, 2022, colorectal cancer screening and associated services are covered at 100% for eligible members aged 45 and older
- Frequency: Using fecal blood testing (gFOBT or FIT) annually, Cologuard every 3 years, sigmoidoscopy or CT / virtual colonography every 5 years, or colonoscopy every 10 years. These tests are available in network.
- More information:
- If you have a positive fecal blood test (gFOBT or FIT or Cologuard), or visualization test (CT colonography or sigmoidoscopy), your doctor may order a follow up colonoscopy. This follow up colonoscopy will be covered at 100%.
- If you had a polyps removed during a previous preventive screening colonoscopy, future colonoscopies will be covered but may not be considered preventive so you may have out of pocket costs.
- Your doctor may order a colonoscopy more frequently than every 10 years. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs.
- Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%.
- Provider consultation prior to the colonoscopy procedure is covered at 100%.
- Certain bowel preparation medications for a screening colonoscopy are covered at 100% when prescribed by a doctor.
- If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this ACA Copay Waiver Criteria (PDF); if you meet these criteria, they can submit this information on the ACA Copay Waiver form (PDF).
- Barium enema is a covered service but not at 100% so you may have out of pocket costs.
