Exact Sciences Corp, Madison, Wis, has announced that the Centers for Medicare and Medicaid Services (CMS) has published an updated 2015 Clinical Laboratory Fee Schedule, which includes reimbursement for the company’s Cologuard noninvasive colon cancer screening test (CPT code G0464) at $492.72.


Kevin Conroy, JD

Consistent with CMS’s final payment decision, issued on November 25, 2014, it will reimburse Cologuard based on a crosswalk to CPT codes 82274, 81275, and 81315. To establish the final 2015 reimbursement rate of $492.72 for CPT code G0464 (Cologuard), CMS utilized an internal calculation based on prior-year locality-specific payment rates for each of the component codes.

“We are pleased with the final reimbursement rate for Cologuard,” says Kevin T. Conroy, JD, chairman and CEO of Exact Sciences. “We appreciate the work done by the team at CMS to make this important noninvasive colorectal cancer screening option available to the millions of patients covered by Medicare.”

The $492.72 reimbursement amount for Cologuard is a national limitation amount that is applicable across all states and applies to Cologuard tests provided to Medicare beneficiaries who are enrolled in traditional Medicare, which is also referred to as Medicare fee for service. Medicare Advantage plans are required by the recent national coverage decision to reimburse for the Cologuard test. Out-of-pocket costs for Medicare Advantage enrollees will be determined by the specific details of their respective plans.