Insurers to cover colonoscopies after positive stool-based tests 

Starting May 31, 2022, insurance plans and issuers must provide no-cost coverage for follow-up colonoscopies.

As documented by the Department of Labor, this direction clarifies a long-standing point of confusion regarding colonoscopies performed after patients receive an abnormal result from a stool-based or direct visualization colorectal cancer screening test. Stool-based tests include the popular fecal immunochemical test (FIT) and stool-DNA test (Cologuard). The directive leverages the United States Preventive Services Task Force (USPSTF) 2021 recommendation, which specified "the benefits of [colorectal cancer] screening can only be fully achieved when follow-up of abnormal screening test results is performed."

The Affordable Care Act requires all preventive screenings be covered by insurance companies with no cost-sharing for their members. Until now, a colonoscopy conducted after an abnormal stool test was often considered a diagnostic test by insurers. The cost of a diagnostic test can be a significant barrier to further testing and treatment, leading to worse outcomes for patients.

“No colorectal cancer screening should be considered complete if there was an abnormal result. We’re thrilled to see such clear guidance to insurers that follow-up colonoscopies are a necessary part of screening completion,” said Marcie Klein, the Alliance’s Vice President of Prevention. “The use of lower-cost and less-invasive screening methods increased during the pandemic and should be celebrated for creating access to screening. Removing the cost barrier of follow-up colonoscopies is a huge step toward creating more equitable access to prevention and early detection of this disease.” 

For years, the Colorectal Cancer Alliance has advocated with other National Colorectal Cancer Roundtable (NCCRT) members for a policy fix to ensure patients do not get billed for this necessary screening step. This new guidance for insurers (available here, starting on page 11) is certain to save lives.

Unfortunately, the clarification does not apply to traditional Medicaid and Medicare plans, except for those who have coverage via Medicaid expansion. Each state could choose to update its Medicaid benefits.

Ready to find out which colorectal cancer screening test is right for you? Learn about which colorectal cancer screening options are best for you based on your personal risk factors.