Excellus BlueCross BlueShieldCommercial · Coverage · Digestive System (Gastroenterology) · NY · Gastroenterology, General Practice, Internal Medicine +1 moreHigh impact
Colorectal Cancer Screening and Surveillance 2.01.51
Effective date
Sep 17, 2026
Identified
Jun 20, 2026
Summary
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.
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01Already effective 2026-09-17: For blood-based colorectal cancer screening tests (for example CPT 0537U or HCPCS G0327), the policy is medically necessary every 3 years only when documentation confirms both that the individual declines or has not completed one of the ACS-preferred CRC screening tests, and that the individual has been informed that blood-based screening has lower sensitivity for detecting advanced precancerous lesions and early-stage colorectal cancer than the preferred tests.
02Keep this documentation with the claim for these services.
03Blood-based biomarker testing not approved by the FDA is considered investigational.
04For multi-target stool RNA testing (CPT 0421U), the policy is medically necessary every 3 years.
05Check current applicability of this policy before billing these services.
Codes mentioned
G0327
Original notice
Colorectal Cancer Screening and Surveillance 2.01.51
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