CommercialBilling CodesMedium impact
State and School Employees' Health Insurance Plan - Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening
Blue Cross & Blue Shield of Mississippi·MS · Family Medicine, Internal Medicine, General Practice +1 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Insurance Plan updated their fecal DNA testing policy to include new Cologuard Plus test (CPT 0464U) alongside existing Cologuard coverage. The policy maintains existing criteria for coverage every 3 years for average-risk individuals aged 45-75.
Action Required
By January 1, 2026: Billing team must add CPT code 0464U to billing system for Cologuard Plus testing. Update prior authorization requirements to include both Cologuard (81528) and Cologuard Plus (0464U) under same coverage criteria. Verify patient eligibility meets all criteria: age 45-75, average risk, no other screening in specified intervals, and no symptoms of colorectal disease.