G0328 Insurance Policy Changes

HCPCS G0328 is officially defined as "Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous." HCPCS G0328 is referenced in 6 tracked payer policy changes from Medicare/CMS - Transmittals, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0328 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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.
Aetna · Effective Jul 1, 2025High impact
OfficeLink Updates - April 2025 notices and reminders (PDF)
Aetna updated their National Precertification List with multiple new drug requirements and removed precertification for BRCA genetic testing. Several new specialty drugs now require precertification with staggered effective dates from March through April 2025, and new claim edits will be implemented starting July 1, 2025.
Independence Blue Cross · Effective Jul 1, 2026Medium impact
11.03.12w, Colorectal Cancer Screening
Independence Blue Cross changed Cologuard Plus coverage from experimental/investigational to medically necessary effective 07/01/2026. CPT code 0464U (colorectal cancer screening with methylated DNA markers) is now covered. Billing teams must update claims processing to reflect this code as medically necessary rather than denying it as experimental.
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.

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REFERENCE DATA

Payers with rules1

Payers requiring prior auth1

Anthem BCBS · Effective September 1, 2026
Prior authorization required in some cases
Virginia Local Precertification/Prior Authorization List (HMO & EPO)

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for G0328?

Anthem BCBS lists G0328 on Virginia Local Precertification/Prior Authorization List (HMO & EPO) for commercial plans, with conditions (list dated September 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS G0328?

There are 6 tracked policy changes affecting HCPCS G0328, including updates from Medicare/CMS - Transmittals, Aetna, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS G0328?

Payers that have issued tracked updates for HCPCS G0328 include: Medicare/CMS - Transmittals, Aetna, Independence Blue Cross.

How do I get notified when HCPCS G0328 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS G0328. 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 G0328?

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 G0328 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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

OfficeLink Updates - April 2025 notices and reminders (PDF)

11.03.12w, Colorectal Cancer Screening

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)

Prior authorization required in some cases

Does Anthem BCBS require prior authorization for G0328?

What insurance policy changes affect HCPCS G0328?

Which payers have updated policy for HCPCS G0328?

How do I get notified when HCPCS G0328 policy changes?

Why do payers change policies for HCPCS G0328?