Laboratory

Laboratory Question for the Week of March 9, 2020

Laboratory Compliance Question of the Week

Question:

What are some of the Medicare criteria for billing code 81528?

Answer:

Understand that code 81528 was added in 2016 for stool-based DNA colorectal cancer screening. Medicare Part B covers this molecular pathology procedure once every three years for beneficiaries meeting all of the following:

  • Between 50 and 85 years old
  • Show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test, and
  • At the average risk of developing colorectal cancer—have no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis; and have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer
81528 Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result

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