The revised national coverage determination allows physician associates and advanced practice registered nurses to order non-invasive stool- and blood-based biomarker assays, including fecal occult blood tests.
The Centers for Medicare & Medicaid Services (CMS) has expanded Medicare coverage for non-invasive colorectal cancer screening tests to include orders placed by physician associates (PAs) and advanced practice registered nurses (APRNs), according to the American Academy of Physician Associates (AAPA).
Under the updated policy, PAs and APRNs are authorized to order all non-invasive colorectal cancer screening assays covered by Medicare, including RNA-based stool tests, DNA-based stool tests, DNA-based blood tests, and fecal occult blood tests (FOBT). CMS finalized the policy revision in June 2026 through a decision memo updating the “Screening for Colorectal Cancer—Non-Invasive Biomarker Tests” National Coverage Determination (NCD).
Previously, the Medicare NCD covered these diagnostic screening tests only when ordered by a physician. CMS reopened the NCD to review the coverage framework after new clinical evidence was submitted regarding stool-based RNA testing.
Advocacy for Diagnostic Test Inclusion
In its initial proposed decision memo, CMS suggested permitting PAs and APRNs to order selected DNA and RNA screening assays, but the agency omitted FOBT from the list of authorized tests.
Following this proposal, AAPA advocated for broader coverage through several regulatory channels, according to the organization. These actions included responding to agency requests for information regarding deregulation, submitting a formal comment letter addressing the proposed NCD memo, and participating in direct discussions between the AAPA Reimbursement and Professional Advocacy Team and the CMS NCD team. CMS subsequently incorporated PA- and APRN-ordered FOBT into the authorized testing list prior to publishing the final memo.
“This policy change demonstrates that CMS is willing to remove barriers to PA practice, but, most importantly, it will give Medicare beneficiaries expanded access to regular screenings that are essential for early detection of colon cancer,” says Sondra M. DePalma, DHSc, PA-C, DFAAPA, AAPA vice president of reimbursement and professional practice, in a release.
Streamlining Clinical Lab Access
Colorectal cancer represents the second leading cause of cancer-related mortality in the US, but it maintains high survival rates when identified in its early stages. By extending ordering authority to PAs and APRNs, the policy revision helps patients obtain laboratory authorizations without having to schedule redundant physician consultations, according to AAPA.
“As a result of these policy changes, patients treated by PAs will be able to obtain authorization for these tests in a more timely manner,” says DePalma in a release.
The updated coverage rules are also expected to decrease administrative burdens across clinical practices and limit healthcare waste by allowing treating non-physician providers to order necessary screening assays directly.
