0163U
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Personal history of colorectal cancer, adenoma, or sessile serrated polyp
- Family history of colorectal cancer in close relatives
- Personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease)
- Personal history of cystic fibrosis
- Genetic and biomarker tests to screen asymptomatic individuals at average risk for specific cancers.
- Genetic and biomarker tests to screen individuals known to be at higher risk for a specific cancer.
2 Active Policies
AMBETTER-CG-Onc-Cancer-Screen-2025.1 — Concert Genetic Oncology: Cancer Screening
REGENCE-LAB41 — Analysis of Proteomic and Metabolomic Patterns for Cancer Detection, Risk, Prognosis, or Treatment Selection
Related Codes
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