Fecal Occult Blood Test: Screening and Diagnostic
Medicare covers some screening procedures. When services are provided for screening purposes, it is important to submit these services with the correct CPT or HCPCS code. Fecal Occult Blood Tests (FOBTs) may be covered for both screening and diagnostic purposes.
- A diagnostic FOBT is one performed based on signs and/or symptoms exhibited by the patient
- A screening FOBT is performed in the absence of signs or symptoms
Medicare covers colorectal cancer screening tests/procedures for the early detection of colorectal cancer when coverage conditions are met. Coverage of these procedures is subject to certain frequency limitations. Among the screening procedures covered is the Fecal Occult Blood Test (FOBT). This test checks for occult or hidden blood in the stool. The test is submitted to Medicare with one of the following codes:
- CPT code 82270 Colorectal cancer screening; fecal-occult blood test
- HCPCS code G0328 Colorectal cancer screening; fecal-occult blood test (alternative to CPT code 82270)
Coverage for Screening FOBT
Medicare covers one screening FOBT annually for beneficiaries aged 50 and older. A written order from the physician responsible for using the results of the test in the management of the beneficiary's medical condition is required for Medicare coverage of this test. A health care provider gives a fecal occult blood test card to the beneficiary, who takes it home and places stool samples on it. The beneficiary either returns the card with the stool samples to the health care provider or to a laboratory for testing.
The date of service reported on the claim should be the date the final card is received from the beneficiary. Report test codes only once as the reimbursement for these codes includes three determinations. Payment is based on the clinical laboratory fee schedule and is made at 100 percent of the allowed amount. The deductible and coinsurance do not apply to this test.
Medicare may also cover a diagnostic FOBT when the procedure is medically necessary. Coverage for diagnostic (non-screening) FOBTs is based on a CMS National Coverage Determination (NCD): Fecal Occult Blood Test.