CommercialCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Family Medicine, Internal Medicine, Gastroenterology·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross added restricted coverage for Cologuard Plus (0464U) genetic testing, covering it only for colorectal cancer screening in average-risk individuals who haven't been screened by another method in the past year. Other stool-based genetic tests including RNA analysis remain excluded.
Action Required
By July 1, 2026: Billing team must update system to allow billing of Cologuard Plus (0464U) only for average-risk colorectal cancer screening when no other screening occurred within the past year. Continue excluding RNA-based stool tests like Colosense (0421U) and combination DNA/RNA tests. Update encounter forms to remind providers of screening interval requirements.