Originally published January 29, 2018. Medicare lowered the starting age for colorectal cancer screening to 45 in 2023. Payer rules change; confirm current CMS and payer requirements before billing.
Medicare covers one screening fecal occult blood test (FOBT) per year for beneficiaries 50 or older. The test must be ordered by the patient's treating physician. Either a guaiac test or a FIT is covered, but not both, and at least 11 months must have passed since the month of the last test.
Screening vs. diagnostic colonoscopy
A screening test is done when the patient has no signs or symptoms. A screening colonoscopy is performed on an asymptomatic patient to check for colorectal cancer or polyps.
A diagnostic colonoscopy is performed because of an abnormal finding, sign or symptom, such as abdominal pain, bleeding or diarrhea. Medicare and most payers do not waive the copay and deductible when the visit is for a diagnostic colonoscopy.
The two types of FOBT
| Immunoassay (FIT) | Chemical (guaiac FOBT) | |
|---|---|---|
| Diagnostic code | 82274-QW | 82272 |
| Screening code | G0328-QW (Medicare), 82274 (commercial), ages 50–75 | 82270, ages 50–75 |
| Example | Hemosure iFOB test | Henry Schein OneStep Occult Blood |
| Approx. reimbursement (2018) | $21 | $4 |
Routine screening diagnosis codes
- Z12.10
- Screening for malignant neoplasm of intestinal tract, unspecified
- Z12.11
- Screening for malignant neoplasm of colon
- Z12.12
- Screening for malignant neoplasm of rectum
Diagnostic tests
When an FOBT is done because the patient has symptoms, use the diagnosis code for those symptoms.