G0327 Insurance Policy Changes

HCPCS G0327 is officially defined as "Colorectal cancer screening; blood-based biomarker." HCPCS G0327 is referenced in 6 tracked payer policy changes from Excellus BlueCross BlueShield, Medicare/CMS - Transmittals, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0327 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Sep 17, 2026High impact
Colorectal Cancer Screening and Surveillance 2.01.51
Blood-based colorectal cancer screening tests changed from investigational to medically necessary when criteria are met, with a current effective date of September 17, 2026. Blood-based tests (for example Shield, CPT 0537U) are medically necessary every 3 years only when documentation confirms that the individual declines or has not completed one of the ACS-preferred screening tests and has been informed that blood-based screening has lower sensitivity for advanced precancerous lesions and early-stage colorectal cancer. The March 19, 2026 revision changed multi-target stool RNA testing (CPT 0421U) every 3 years from investigational to medically necessary.
Medicare/CMS - Transmittals · Effective Jun 8, 2026High impact
R13921CP: NCD 210.3 Screening for Colorectal Cancer-Non-Invasive Biomarker Tests
CMS determined that, effective June 8, 2026, non-invasive biomarker colorectal cancer screening tests are covered for Medicare beneficiaries under NCD 210.3 when they meet specific criteria. Covered tests are limited to once every three years for asymptomatic, average-risk patients aged 45 to 85, and the test must be FDA market authorized and indicated for colorectal cancer screening, processed in a CLIA certified laboratory, and meet defined sensitivity and specificity thresholds. The transmittal adds ColoSense (0421U) as a covered screening test and sets an implementation date of January 4, 2027 for the claims processing changes.
Independence Blue Cross · Effective Jul 1, 2025Medium impact
11.03.12v, Colorectal Cancer Screening
Independence Blue Cross removed barium enema from covered colorectal cancer screening tests effective 07/01/2025, aligning with 2018 American Cancer Society and 2024 American College of Radiology guidelines. Additionally, two new tests (BeScreened-CRC and FirstSight CRC) were classified as experimental/investigational and are no longer covered.
Aetna · Identified Oct 2, 2026Medium impact
Colonoscopy, Colorectal Cancer Screening, and Related Procedures (CPB 0516, reviewed 2026-08-20)
Aetna Clinical Policy Bulletin 0516 sets the coverage rules for colonoscopy, colorectal cancer (CRC) screening and related procedures. For average-risk members aged 45 and older whose physician recommends screening, Aetna considers medically necessary colonoscopy every 10 years, CT colonography every 5 years, annual FIT or FOBT, flexible sigmoidoscopy every 5 years (or every 10 years when combined with an annual FIT or FOBT), and stool DNA tests (FIT-DNA, Cologuard, Cologuard Plus) every 1 to 3 years. Colonoscopy or sigmoidoscopy is considered medically necessary as frequently as every 2 years for members with specified high-risk factors, and surveillance is considered medically necessary as frequently as every year for inflammatory bowel disease or a personal history of CRC and every 2 years for a personal history of adenomatous polyps. Aetna considers double contrast barium enema not medically necessary for screening, high-risk testing, surveillance and diagnostic testing, and considers AI-aided colonoscopy, Guardant Shield, and several other blood, stool and imaging-based screening methods experimental, investigational or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Colonoscopy, Colorectal Cancer Screening, and Related Procedures (CPB 0516, reviewed 2025-11-12)
Aetna considers colorectal cancer screening medically necessary for average-risk members aged 45 years and older when their physician recommends it, with colonoscopy every 10 years, CT colonography every 5 years, annual FIT or FOBT, flexible sigmoidoscopy every 5 years, flexible sigmoidoscopy every 10 years when combined with annual FIT or FOBT, and stool DNA every 1 to 3 years. Colonoscopy or sigmoidoscopy as frequently as every 2 years is considered medically necessary for members with a first-degree relative who had CRC or adenomatous polyps, familial adenomatous polyposis, hereditary non-polyposis CRC, MYH-associated polyposis in siblings, or Cowden syndrome, and surveillance is considered medically necessary as frequently as every year for inflammatory bowel disease or a personal history of CRC. Double contrast barium enema is not considered medically necessary, and AI-aided colonoscopy, blood-based biomarkers, Guardant Shield, stool-based protein biomarkers, fecal volatile organic compound analysis, anal Pap smear, drug-coated balloons for colonic strictures, and the full-thickness resection device for appendiceal polyps are considered experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Genetic Testing
Genetic testing is considered medically necessary to establish a molecular diagnosis of an inheritable disease when the member displays clinical features or is at direct risk of inheriting the mutation in question, the result of the test will directly impact the treatment being delivered to the member, and a definitive diagnosis remains uncertain after history, physical examination, and completion of conventional diagnostic studies. Section I lists inheritable diseases for which genetic testing is medically necessary when these criteria are met, and Section II lists specific tests, including BRCAnalysis, Breast Cancer Index, Cologuard, and Alzheimer's disease testing, that are medically necessary when their own criteria are met. Section III lists tests considered investigational for conditions such as arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), Parkinson's disease, and migrainous vertigo. Section IV states that any genetic test not listed as medically necessary in Sections I or II is investigational, and that any home genetic test is investigational.

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REFERENCE DATA

Payers with rules4

Payers requiring prior auth4

BCBS Arizona · Effective October 1, 2026
Prior authorization required in some cases
AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026)
Arizona Complete Health · Effective December 31, 2025
Prior authorization required
Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does AmeriHealth Caritas require prior authorization for G0327?

AmeriHealth Caritas lists G0327 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for G0327?

Arizona Complete Health lists G0327 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for G0327?

BCBS Arizona lists G0327 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does Capital Blue Cross require prior authorization for G0327?

Capital Blue Cross lists G0327 on Capital Blue Cross single source preauthorization code list for commercial plans, with conditions. Verify with the payer before scheduling.

What insurance policy changes affect HCPCS G0327?

There are 6 tracked policy changes affecting HCPCS G0327, including updates from Excellus BlueCross BlueShield, Medicare/CMS - Transmittals, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS G0327?

Payers that have issued tracked updates for HCPCS G0327 include: Excellus BlueCross BlueShield, Medicare/CMS - Transmittals, Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when HCPCS G0327 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS G0327. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS G0327?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for G0327 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Colorectal Cancer Screening and Surveillance 2.01.51

R13921CP: NCD 210.3 Screening for Colorectal Cancer-Non-Invasive Biomarker Tests

11.03.12v, Colorectal Cancer Screening

Colonoscopy, Colorectal Cancer Screening, and Related Procedures (CPB 0516, reviewed 2026-08-20)

Colonoscopy, Colorectal Cancer Screening, and Related Procedures (CPB 0516, reviewed 2025-11-12)

Genetic Testing

Prior authorization required in some cases

Prior authorization required