All PlansCoverageMedium impact
Analysis of Human DNA or RNA in Stool Samples as a Technique for Colorectal Cancer Screening
Regence BlueShield·Gastroenterology, Family Medicine, Internal Medicine +1 more·Coding
Effective date
May 1, 2026
We identified it
Jun 16, 2026
Summary
New policy defines coverage for DNA/RNA stool testing for colorectal cancer screening. Only Cologuard (CPT 81528) and Cologuard Plus (HCPCS 0464U) are considered medically necessary, while all other fecal DNA/RNA tests including ColoSense are deemed investigational and not covered.
Action Required
Before May 1, 2026: Billing team must update system to only bill CPT 81528 (Cologuard) and HCPCS 0464U (Cologuard Plus) for covered colorectal cancer DNA screening. Block billing for all other fecal DNA/RNA tests including ColoSense as investigational. Inform providers that patients will be financially responsible for non-covered tests.