NCD for Screening for Colorectal Cancer Using Cologuard – A Multitarget Stool DNA Test

Effective for claims with dates of service on or after October 9, 2014, Medicare will recognize new HCPCS code G0464, (Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (for example, KRAS, NDRG4 and BMP3)) as a covered service. Only laboratories authorized by the manufacturer to perform the Cologuard™ test may bill for this service. Claims for HCPCS code G0464 must also include ICD-9 diagnosis codes V76.41 and V76.51. Once ICD-10 is implemented, the claim must reflect ICD-10 diagnosis codes Z12.12 and Z12.11.