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Does United Healthcare Cover Cologuard?

Does United Healthcare Cover Cologuard
United Healthcare Includes Exact Sciences’ Cologuard in Coverage Document NEW YORK (GenomeWeb) – United Healthcare has included coverage of fecal DNA testing for colorectal cancer in its latest Coverage Determination Guideline, making it the final big US insurer to cover Exact Sciences’ Cologuard, according to analysts who cover the firm.

The decision marks a reversal for United Healthcare, which had recently declined to cover Cologuard, citing insufficient evidence to show that fecal DNA tests accurately screen for colorectal cancer in asymptomatic, average-risk patients. Effective July 1, United Healthcare will cover fecal DNA testing for patients 50 to 75 years old once every three years.

The insurer became the latest to cover Cologuard. In late March, Aetna issued updated its colorectal cancer screening policy to note that it now considers Exact Sciences’ Cologuard screening test a “medically necessary preventive service” every three years for average-risk patients 50 and older.

  1. Aetna also considers colorectal cancer screening medically necessary for African Americans starting at 45.
  2. Among the other major payors to have previously included Cologuard in their coverage guidelines are Cigna, Humana, and Tricare.
  3. According to Cowen analyst Doug Schenkel, with the United Healthcare coverage, Exact Sciences should have around 95 percent of lives covered heading into 2018.

“It usually takes 12 months for a coverage decision to be contracted in network,” Schenkel wrote. “That being said, getting a positive coverage decision from the largest US commercial payor and the last major holdout is a clear positive and should address any lingering concerns/arguments about the company’s ability to gain what is considered ‘full coverage’ heading into 2018.” Canaccord Genuity analyst Mark Massaro added in a note this morning that he estimates United Healthcare will add around 30 million covered lives for Cologuard, bringing the total number of lives covered to approximately 227 million.

  1. Brian Weinstein of investment bank William Blair wrote that “by the middle of 2018 most payers should be contracted at, or above, the current rate of $510.
  2. We maintain that management has no incentive or requirement to drop its price below the level paid by the largest payer in the country and as a result, we suspect this rate will hold for United and everyone else.” In Wednesday morning trade on the Nasdaq, shares of Exact Sciences were up around 10 percent at $36.02.

The firm’s stock has rebounded from a hit it took in mid-May, after short seller Citron Research put out a report saying Cologuard was “a seriously inferior product,” and questioned Exact Sciences’ business model. Citron also not to cover the test as further proof of its thesis.

Do insurance companies pay for cologuard?

Cologuard is covered by Medicare and most major insurance for a majority of patients. screening. have no out-of-pocket costs.

How much does a cologuard test cost?

How much does Cologuard cost? – The cost of Cologuard is around $500. Â Part of that cost may be covered by some insurances depending on your plan, co-pay, and deductible. Â Diagnostic testing is subject to deductibles and coinsurance. Screening colonoscopies are not subject to copays and deductibles and usually have no out-of-pocket costs for patients.

How to get a free cologuard kit?

All people 45 years and older should be tested for colon cancer. – Did You Know. Colon cancer is the #2 cause of cancer deaths, but it doesn’t have to be. Screening tests can find colon cancer early when treatment works best. Tests can find growths (polyps) so they can be removed before they turn into cancer.

  • Colon cancer or polyps may not cause symptoms, especially early on.
  • Don’t wait for symptoms before you get tested.
  • More than half of deaths from colon cancer could be prevented with regular testing.
  • Uninsured? Call 1-888-345-0225 or fill out the form below to learn about free colon cancer screening and find out if you’re eligible to have a free FIT kit (at-home stool test) mailed to you.

Please note that this service is for New York State residents only. For out-of-state guests, please visit the CDC’s website to find resources. There is more than one test for colon cancer screening. Talk to your health care provider. Whichever test you choose, getting screened is the right choice.

Will insurance pay for both cologuard and colonoscopy?

New Insurance Guidance Benefits Patients Does United Healthcare Cover Cologuard

Many patients getting screened for colorectal cancer (CRC) soon will not have to pay out of pocket for a follow-up colonoscopy to evaluate a positive, non-invasive CRC-screening test.New federal guidance released in January will soon require health plans to fully cover the cost of a follow-up colonoscopy to evaluate a positive result from an MTs-DNA stool-based test (Cologuard) as well as a fecal immunochemical test (FIT).”Ensuring individuals have access to this lifesaving will significantly reduce suffering and death from this disease,” Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN), told MedicalXpress.

It is important to understand that if your FIT or Cologuard test comes back positive for colon cancer, a colonoscopy is critical for your health. You are twice as likely to develop more advanced colon cancer if you skip this follow-up procedure. In the past, cost has been a significant barrier to many people, making it a primary reason not to get the follow-up colonoscopy.

This new follow-up screening coverage is for plan or policy years beginning on or after May 31, 2022. Patients need to check with their insurance provider about this coverage. “This guidance will help ensure that patients can choose the test that is best for them without worrying about out-of-pocket costs,” Anjee Davis, MPPA, president of Fight Colorectal Cancer told MedicalXpress.

“Ultimately, this will save lives and support early detection of colorectal cancer.”

Is the cologuard test free?

What would someone on Medicare expect to pay for a colorectal cancer screening test? –

FOBT/FIT: Covered at no cost for those age 45 or older* (no co-insurance or Part B deductible). Stool DNA test (Cologuard): Covered at no cost* for those age 45 to 85 as long as they are not at increased risk of colorectal cancer and don’t have symptoms of colorectal cancer (no co-insurance or Part B deductible).

It’s important to know that if you have a positive result on a screening FOBT, FIT or stool DNA lab test, Medicare will cover the cost of a follow-on screening colonoscopy. You will not have to pay for this test as long as your doctor or other qualified health care provider accepts assignment.

Colonoscopy: Covered at no cost* at any age (no co-insurance, co-payment, or Part B deductible) when the test is done for screening. Note: If the test results in the biopsy or removal of a growth, it’s no longer a “screening” test, and you will be charged the 15% co-insurance and/or a co-pay (but you don’t have to pay the deductible). Flexible sigmoidoscopy: Covered at no cost* (no co-insurance, co-payment, or Part B deductible) when the test is done for screening. Note: If the test results in the biopsy or removal of a growth, it’s no longer a “screening” test, and you will be charged the 15 co-insurance and/or a co-pay (but you don’t have to pay the Part B deductible). Double-contrast barium enema: You pay 20% of the Medicare approved amount for the doctor services. If the test is done in an outpatient hospital department or ambulatory surgical center, you also pay the hospital co-payment (but you don’t have to pay the Part B deductible).

If you’re getting a screening colonoscopy (or sigmoidoscopy), be sure to find whether you might have to pay for any related charges. This can help you avoid surprise costs.

Ask how much you will have to pay if a polyp is removed or a biopsy is done. You may have a co-pay 15% of the Medicare-approved amount for the doctor’s services. You may also have to pay for the bowel prep kit unless your Medicare Part D or Medicare Advantage plan covers the cost. Depending on where your colonoscopy is done, you may have to pay 15% co-insurance for a facility fee.

*This service is covered at no cost as long as the doctor accepts assignment (the amount Medicare pays as the full payment). Doctors that do not accept assignment are required to tell you up front.

Can I order cologuard myself?

Types of At-Home Colon Cancer Tests – Three types of at-home colorectal cancer tests are available. Each involves self-collection of a stool sample, but there are important differences in how the sample is prepared and how the testing is carried out. Fecal occult blood tests (FOBTs) and fecal immunochemical tests (FITs) can be obtained with or without a prescription.

  • FIT-DNA tests are only available with a prescription.
  • Instructions for properly preparing for and taking the test can vary based on the type of test and the manufacturer, so it is important to look closely at the specific directions and materials included in any test kit.
  • Below you can find information about several of the best at-home colorectal cancer tests that are currently available.

Best Overall Labcorp OnDemand Colorectal Cancer At-Home Test Price: $89 Type: Self-collection Sample: Stool Tests for: Blood in stool Results timeline: Within about 2 days after sample is received by lab The Labcorp OnDemand Colorectal Cancer At-Home Test uses fecal immunochemical testing (FIT) to detect blood in the stool.

This technique can help find signs of polyps and colorectal cancer. After you place an order, Labcorp OnDemand will send a full test kit directly to your home. The kit includes detailed instructions and all the materials needed to collect your test sample. You can take the test when you are having a normal bowel movement.

Place a collection paper into your toilet to catch your stool specimen. Remove the small collection wand from inside the plastic tube included in the test kit. Scrape your stool with the wand to collect a tiny sample and place the collection wand back into the tube.

  1. Package your sample in the included mailer and send it to the laboratory.
  2. Once the CAP-accredited, CLIA-certified lab receives your sample, it will conduct the FIT to check for blood in the stool.
  3. Results are usually available within two days after your sample arrives.
  4. You can access your test result through a secure website, and you may also receive a follow-up call or email if needed.

Free shipping is included both ways, and the test can be paid for by many HSA and FSA plans. Since the test checks for blood, it’s important to wait to take it if you have blood in your stool from hemorrhoids or blood in your urine. These symptoms should be discussed with your physician.

  1. You should also wait to take the test if you just started your menstrual cycle.
  2. Best Prescription-Only Option Cologuard Price: Varies based on insurance Type: Self-collection Sample: Full stool sample Tests for: Blood in stool and abnormal DNA Results timeline: Within 14 days after mailing your sample Cologuard is an at-home FIT-DNA test that can detect both blood in the stool and abnormal DNA that can come from colon polyps.
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It is a widely accepted, FDA-approved method of colorectal cancer screening. Cologuard is only available with a prescription. Your primary care provider can order the test, and you can also work with a telemedicine provider who can help prescribe the test if you meet the criteria for colorectal cancer screening.

Once the test is prescribed, Cologuard ships you a box containing all the materials you need to prepare your sample. The kit includes a container and brackets to place it properly in your toilet. You will need to collect a full bowel movement while avoiding urine or putting any toilet paper in the container.

After you’ve finished going to the bathroom, use the enclosed device to scrape up a small sample of stool and place that device in the provided tube. Add the liquid from the test kit to the container and close it securely. Seal the container and tube in a plastic bag, then put the bag into the prelabeled box and ship the test back to the lab.

The Cologuard test includes an FIT analysis that checks your stool for traces of blood. It also analyzes your sample for any abnormal DNA that could come from colorectal polyps. Results are available within two weeks and are usually sent directly to your health care provider. Cologuard is available for free or at a low cost for most people with health insurance in the United States, but the exact amount that you will pay depends on your insurance plan.

There are no required pretest preparations for the Cologuard test, but you should wait to take this test if you are on your period, have recently noticed blood in your stool or urine, or have hemorrhoids. Best for FSA/HSA Payments LetsGetChecked – Colon Cancer Screening Test Price: $89 (Get 25% off with your exclusive discount code.

  1. Use code TESTING25 at checkout.) Type: Self-collection Sample: Stool Tests for: Blood in stool Results timeline: Within 2 to 5 days after sample arrives at lab The LetsGetChecked Colon Cancer Screening Test is an FIT that provides a straightforward way to conduct colorectal cancer screening.
  2. Since LetsGetChecked accepts FSA and HSA payments directly through their website, this test is our pick for the best choice for people looking to use these accounts to pay for testing.

LetsGetChecked offers free shipping to send the test kit to your home. The kit has all the information and materials needed to collect a sample and send it back to their CAP-accredited, CLIA-certified lab with a prepaid return shipping label. Please contact UPS to arrange a pickup before you collect your sample.

You should collect your sample on the same day as the pickup is scheduled for. Visit the UPS pickup scheduling page or call 1-800-742-5877 to schedule a pickup to return your sample. You’ll be asked to provide some information including your tracking number, pickup address and pickup day and time. Please keep your tracking number to help you track your package.

To collect a sample, place a piece of collection paper into your toilet when you anticipate having a bowel movement. Defecate into the toilet and onto that paper. Then remove the collection wand from the kit’s small tube and use it to lightly scrape your stool.

  • Once you have a small sample of stool on the collection wand, put it back into the tube.
  • Place the sealed tube into a biohazard bag, then seal and package the sample for shipping.
  • When the sample arrives at the lab, a fecal immunochemical test is performed to look for any indications of blood in your stool sample.

The results are accessible within 5 days on a secure online account with the ability to see the test report on your smartphone. LetsGetChecked has a team of nurses you can contact with questions before, during, or after taking your test. There are no special precautions or dietary changes required before taking the LetsGetChecked Colon Cancer Screening Test, but you should not take the test if you have blood in your stool or urine or if you are on your period.

Best for People Over 45 Everlywell – FIT Colon Cancer Screening Test Price: $49 Type: Self-collection Sample: Stool swab Tests for: Blood in stool Results timeline: Within 5 days after sample arrives at the lab The Everlywell FIT Colon Cancer Screening Test is an at-home test that lets you quickly obtain a stool sample that can be sent to a laboratory for testing.

This fecal immunochemical test (FIT) checks for signs of blood in the stool that can’t be seen by the naked eye. The test kit includes a special test card, two long-handled brushes to help obtain your sample, and a waste bag. To take the test at-home, flush the toilet and then have a normal bowel movement.

  1. All used toilet paper should be placed in the waste bag instead of into the toilet.
  2. Use the brushes to obtain small samples of stool and apply them to the test card.
  3. Then seal and ship your test card to the lab.
  4. Everlywell offers this test as a form of colorectal cancer screening, and it is only available to people who are over age 45.

Results are provided within five days after the laboratory receives your sample. You can access your results through the company’s smartphone app, but the test report is also printable, making it easier to share with your doctor. The cost of the test includes free shipping both ways, and Everlywell accepts HSA and FSA payments.

  • Both written and video instructions are available to help you properly collect your test sample.
  • As with other FITs, you do not need to change your diet or medications before taking this test.
  • However, if you have recently had hemorrhoids, blood in your urine, or started your menstrual cycle, you should wait before taking it.

Fastest Results Pinnacle BioLabs Second Generation FIT® test Price: $24.99 Type: Self-test Sample: Stool Tests for: Blood in stool Results timeline: Within 7 minutes Because it’s a self-test, meaning you can collect the sample and conduct the analysis at home without sending anything to a lab, the Pinnacle BioLabs Second Generation FIT offers the fastest results of our top picks.

The test kit contains all of the materials needed to carry out the self-test and see if there is blood in your stool. After placing a collection paper in the toilet, go to the bathroom normally and allow your stool to fall onto the paper. Then use a collection wand to scrape the stool and collect a very small sample.

Place the collection wand in the provided tube, which contains a small amount of a chemical reagent. Shake the tube several times, and then place three drops from the tube onto the test cassette. After 4 to 7 minutes, the results should be available. You can tell whether the test is positive or negative by looking at the test cassette and seeing how many lines are visible.

Make sure to check for results no later than seven minutes after taking the test. Any results after this time period may not be valid. Pinnacle BioLabs manufactures every test kit in the US, and the company will ship the kit to your home for free. As with the other tests on our list, you should wait to conduct the test if you have recently had hemorrhoids or any other health issue that might cause blood in your stool.

You should also wait if you have started your menstrual cycle or have recently had blood in your urine.

Can I just do cologuard instead of colonoscopy?

Does United Healthcare Cover Cologuard The simple answer is No, Is the Cologuard answer better than no test at all? Yes! All Gastroenterology Consultants of San Antonio (GCSA) physicians agree that any CRC screening test is better than doing nothing at all. Patients need to understand the limitations and costs of CRC screening tests before making the testing decision with their physician.

  1. We are sure you have seen one of the many attention-grabbing commercials for Cologuard stating all kinds of facts and how easy the process is.
  2. Cologuard is spending millions on advertising, but it’s impossible for patients to get all the information they need in a TV commercial.
  3. It’s true, Cologuard offers benefits of comfort and convenience, but the Cologuard test is not recommended by GCSA physicians as a replacement for a colonoscopy.

Colon cancer claims over 50,000 lives every year and is the 2nd most common cause of cancer death in the US. Colon cancer is preventable, treatable, and beatable – but only with early and accurate detection. Undergoing a colonoscopy may not be the most pleasant experience one could have, but once it is complete, there is not only a lasting peace of mind, most will not need to have the test performed again for another 10 years.

  1. Stool DNA (Cologuard) testing is designed for cancer detection, not prevention. Colonoscopy is detection and prevention and only needs to be done every 10 years for cancer-free patients.
  2. Stool DNA (Cologuard) testing has a 12% false-positive rate. A positive test requires a diagnostic colonoscopy to remove cancerous polyps.
  3. Screening colonoscopies are not subject to copays and deductibles and usually have no out-of-pocket costs for patients. Diagnostic testing is subject to deductibles and coinsurance. The 12% false-positive rate of Stool DNA (Cologuard) will increase the cost for most patients over the 10-year screening period.
  4. Stool DNA (Cologuard) is not indicated for high-risk patients (family history of CRC, IBD, personal history of polyps) or for those with gastrointestinal symptoms.

Cologuard Test: Detection Not Prevention The Cologuard test is designed to detect cancer not prevent it. Cologuard can only detect 42% of large polyps, while a colonoscopy can detect 95% of large polyps. When polyps are detected during a colonoscopy they are removed at the same time.

If polyps are detected with Cologuard, a colonoscopy must be performed to remove them. The majority of large precancerous polyps cannot be detected with Cologuard. This may give patients a false sense that they are preventing colon cancer by taking the Cologuard test. In short, there is no true replacement for a colonoscopy.

Thanks to its overwhelming success rate at detecting colorectal cancer even before it develops, the disease has become one of the most preventable forms of cancer. While other tests such as Cologuard are available and may have some benefits such as requiring minimal preparation and invasiveness, the results provided are less reliable, and patients whose results do indicate a problem will still need to undergo a colonoscopy for confirmation.

Do doctors recommend cologuard?

Why the Test is Performed – The test is done to screen for colon and rectal cancer and abnormal growths (polyps) in the colon or rectum. Your provider may suggest Cologuard testing once every 1 to 3 years after age 45 years. The test is recommended if you are between ages 45 to 75 years and have an average risk of colon cancer. This means that you do not have:

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Personal history of colon polyps and colon cancerFamily history of colon cancerInflammatory bowel disease ( Crohn disease, ulcerative colitis )

Is cologuard as good as a colonoscopy?

No, the Cologuard test is not as effective as a colonoscopy. Detecting and removing polyps is critical to colon cancer prevention, and Cologuard only detects large precancerous polyps 42% of the time. A colonoscopy detects the same polyps 95% of the time and they are removed during the same procedure.

Can I buy Cologuard over the counter?

A Cologuard test requires a prescription from your doctor.

Who is not eligible for cologuard?

Who is Cologuard Right For? | Cologuard® For HCPs Indications and Important Risk Information Cologuard is intended for the qualitative detection of colorectal neoplasia associated DNA markers and for the presence of occult hemoglobin in human stool. A positive result may indicate the presence of colorectal cancer (CRC) or advanced adenoma (AA) and should be followed by colonoscopy.

  • Cologuard is indicated to screen adults of either sex, 45 years or older, who are at typical average risk for CRC.
  • Cologuard is not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high-risk individuals.
  • Cologuard is not for high-risk individuals, including patients with a personal history of colorectal cancer and adenomas; have had a positive result from another colorectal cancer screening method within the last 6 months; have been diagnosed with a condition associated with high risk for colorectal cancer such as IBD, chronic ulcerative colitis, Crohn’s disease; or have a family history of colorectal cancer, or certain hereditary syndromes.

Positive Cologuard results should be referred to colonoscopy. A negative Cologuard test result does not guarantee absence of cancer or advanced adenoma. Following a negative result, patients should continue participating in a screening program at an interval and with a method appropriate for the individual patient.

  1. False positives and false negatives do occur.
  2. In a clinical study, 13% of patients without colorectal cancer or advanced adenomas received a positive result (false positive) and 8% of patients with cancer received a negative result (false negative).
  3. The clinical validation study was conducted in patients 50 years of age and older.

Cologuard performance in patients ages 45 to 49 years was estimated by sub-group analysis of near-age groups. Cologuard performance when used for repeat testing has not been evaluated or established. Rx only. : Who is Cologuard Right For? | Cologuard® For HCPs

Why is cologuard not for everyone?

Con – Cologuard is NOT recommended for higher-risk individuals – Cologuard is not recommended for higher-risk patients that have had colon cancer, have a family history, have inflammatory bowel disorders like Crohn’s disease or have had a personal history of colon polyps.

How is Cologuard billed?

Cologuard is only billed under CPT code 81528.

Do cologuard kits expire?

Each Cologuard prescription and kit have expiration dates. The kit expiration date is on the box it comes in. Make sure to check and use your kit before the expiration date.

How often does Medicare pay for cologuard?

How Often Does Medicare Pay for the Cologuard Test? – Medicare covers a Cologuard test every three years for people aged 50-85 with an average risk of developing colorectal cancer. As Medicare considers Cologuard a preventive diagnostic tool, the American Cancer Society do not recommend a higher frequency of Cologuard testing for low-risk individuals.

How long does it take to receive cologuard kit?

Please take advantage of our newest program for obtaining colon cancer screening Non-invasive and no-prep Colorectal Cancer screening kit from Exact Science called COLOGUARD. You must be Tricare Prime beneficiary age 50+. COLORGUARD frequently asked questions Do I need to do anything to prepare for this test? Please carefully read the instructions that arrived with the Cologuard Collection Kit prior to collecting the sample. No other special preparation is required. Do I need to stop taking any medications prior to using the test? No, there is no need to stop any medications prior to collecting a sample for Cologuard.

  • Are there any dietary restrictions for this test? No, there are no known dietary issues or restrictions that would interfere with an accurate Cologuard result What comes in the test kit? Where will I get it? After we send the completed order slip from your healthcare provider, Dr.
  • Eugene Kastelberg, you will receive a Collection Kit to the address you provided.

We may need to contact you ahead of shipment if any information from the order form is missing. Once you receive the Collection Kit in the mail, open the kit for sample collection instructions. You will also receive a prepaid return shipping label, and Exact Sciences Laboratories phone number, in case you have any additional questions.

  1. How should I send the collection kit back to the lab? The Collection Kit (with the sample inside) should be mailed back to our Exact Science Lab using the prepaid return shipping label.
  2. Bring your sample, the original box, and prepaid label at any UPS store or shipping location, or you can call 1-800-823-7459 to schedule a pick-up at your home.

Please note that the sample must be shipped within 24 hours of collection, and received by our lab within 72 hours of collection. We recommend shipping your return kit Monday through Thursday for this reason. There is a Pre-addressed return label that we provide.

I received a kit but it is damaged (or missing a part). What should I do? Please call Exact Sciences Laboratories Customer Support Center at 1-844-870-8870, Our support specialists will confirm your information and help determine if a new kit should be sent to you. I could not mail my test for a few days after taking it.

Is that okay? Our lab needs to receive the sample within 72 hours following collection to ensure test accuracy, so we recommend shipping it within 24 hours of collection. If you are concerned that your sample will not arrive within 72 hours of collection, please call Exact Sciences Laboratories Customer Support Center at 1-844-870-8870.

  1. How will I know if my sample is “normal”? It is most important to get a ‘typical sample’ for you.
  2. For example, if you normally have loose stool, go ahead and take the test.
  3. If you do not normally have loose stool, it is best to wait until the stool returns to its normal consistency.
  4. However, if you are sick and have diarrhea, you should not collect a sample.

If you have any specific concerns, please call Exact Sciences Laboratories Customer Support Center at 1-844-870-8870. How should I store the sample before returning it to the lab? Samples should be stored in the Cologuard Collection Kit at room temperature, and returned to our lab within 72 hours from the time of collection.

How long does it take to receive the results? Your Cologuard test result will typically be delivered to your healthcare provider within two weeks of our lab receiving a sample. If you returned your sample to the lab more than two weeks ago but still haven’t received your results, please call Exact Sciences Laboratories Customer Support Center at 1-844-870-8870.

HOW DO I GET MY RESULTS? Your provider team will call to set up a Virtual visit to go over your results with you. Your provider is Dr. Eugene Kastelberg. Kenner Family Medicine clinic contact information (804)734-9993. What does a positive result mean? A positive result does not necessarily mean that you have cancer.

  • It means that Cologuard detected DNA and/or hemoglobin biomarkers in the stool which are associated with colon cancer or pre-cancer.
  • False positive and false negative results may occur with Cologuard and appropriate follow-up is important.
  • Patients with a positive result should see your provider and may be scheduled for a diagnostic colonoscopy.

Patients with a negative diagnostic colonoscopy following a positive Cologuard result do not require additional clinical evaluation and should continue in a screening program appropriate for you, recommended by your healthcare provider. What does A negative result mean? A negative r esult means that Cologuard did not detect significant levels of DNA and/or hemoglobin biomarkers in the stool which are associated with colon cancer or pre-cancer.

False positives and false negatives occur with Cologuard and appropriate follow-up is important. If you have a negative result, you should continue in a screening program appropriate for you, recommended by your healthcare provider. Cologuard is recommended by the American Cancer Society every 3 years.

Front Desk Contact information (804) 734-9993 Family Medicine Clinic Dr. Eugene Kastelberg, MD

What is an alternative to cologuard test?

Fecal Immunochemical Test (FIT) – The fecal immunochemical test (FIT) checks for hidden blood in your stool, which may be an early sign of colon cancer. Like a Cologuard, you can do this test at home. You do not need to skip your medications or meals, as neither can affect the results of the test.

A significant advantage of this test is that it has fewer false-positive results. However, if you test positive, your GI specialist may still order a colonoscopy for further investigation. Blood in stools is not necessarily an indicator of cancer or polyps, as there are also other conditions that can be taken into account, such as hemorrhoids and ulcers.

You, therefore, need to let your doctor know if you have anal fissures or hemorrhoids or are menstruating before you submit your sample.

Is a stool in a box better than a colonoscopy?

Why would I choose the mail-in option? – If you are at an average risk for colorectal cancer, there are several advantages to choosing the mail-in fecal immunochemical tests (FIT) option. No.1: You can brag to your friends that you’re getting FIT, and they’ll think you’re just exercising and not sending poop in the mail.

  • No.2: You just have to go number two, which is considerably less invasive and uncomfortable than a colonoscopy (we hope — if not, call your doctor now).
  • No.3: We’re still in a pandemic, and the less contact you have with other people, the better.
  • No.4: You don’t have to prepare for the test.
  • You just let it go like you normally would.

However, there are some reasons this option isn’t as comprehensive as a colonoscopy. Mail-in stool tests have a 92% sensitivity rate for detecting colon cancer, which is on par with a colonoscopy, but only a 17% sensitivity rate for detecting cancer-causing polyps.

Does insurance cover stool tests?

Over-the-Counter Test Kits: $5-$35 Professional Testing: $40-$100

/td> Stool testing is done to identify bacteria or viruses that might be causing problems in a patient. A stool culture is collected and placed under conditions that promote the growth of bacteria. The type of infection is identified from a chemical analysis of the growth on the stool sample. Typical costs:

  • Over-the-counter kits are available for home stool testing. The kits, available in most pharmacies, cost about $5-$35, The Colon Health Check Test is $35 and takes about five minutes to complete. The test screens for early signs of colon cancer and checks for blood in the stool. The EZ Detect Stool Blood Test costs $6-$10 at various retail outlets. It checks the stool sample for blood which can be an indicator of bleeding ulcers, hemorrhoids, polyps, colitis or cancer.
  • Professional labs offer stool culture testing services for about $40-$100, First Choice Labs USA provides stool testing services from $45-$95, depending on the extent of the testing. MyMedLab charges $33-$41 for a basic stool culture and $52-$63 for the more extensive testing for parasites in stool.

Related articles: Colonoscopy, Virtual Colonoscopy, Health Insurance What should be included:

  • A home stool testing kit typically includes collection cloths, a package for testing the sample and instructions. Some kits also include a card to record the results and send to a personal physician.
  • Some home testing kits contain a collection jar that is sent to a lab for testing.
  • When working directly with a lab, expect to be given a sterile container for collection of the sample. The sample needs to be immediately sent to the lab or refrigerated. Typically, the lab will allow two to three days for bacteria to grow on the sample before testing it. The bacteria will then be examined and identified under a microscope. Stool samples are also frequently tested for parasites or eggs. WebMD explains in detail the procedure for a stool culture.


  • A stool test might be covered by a medical insurance provider. Contact the insurance provider for specific coverage details.
  • Medicare covers colorectal screening tests for individuals older than 50. The Department of Health and Human Services provides some guidelines on Medicare coverage of certain stool tests.

Shopping for stool testing:

  • Colon Health Magazine is a useful resource for a broad range of information relating to colon health and colorectal cancer.
  • Bronson Health, a Michigan-based hospital, provides a patient’s guide to stool collection.
Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
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/td> CostHelper News What People Are Paying – Recent Comments

Posted by: RBR in Minneapolis, MN. Posted: July 24th, 2022 02:07PM
Type of Test: Test panel for bacteria

Gotta love how the clinics upcharge a service like this.

Posted by: J Newhouse in Rapid City, SD. Posted: July 29th, 2021 09:07PM
Type of Test: Stool Sample

I am so angry that I was charged so much without knowing it would cost anything. It came back that I had two types of E-coli, but after antibiotics I’m still having abdominal pain and am returning to the doctor tomorrow. I am very frustrated that today I received a notice in the mail that I owe $693 after a deductible from my first Urgent Care visit. There should be more upfront communication, because my insurance stated I only have a $25 copay for Urgent care and primary care.

Posted by: Georgiy Levashovo in Los Angeles, CA. Posted: April 5th, 2021 12:04PM
Type of Test: Stool Panel test

I took the same test a year ago and was charged $500 cash. I decided to take this test this year to see if bacteria was gone, and decided to use insurance. The bill went up to $2,500. What is going on here? Is it rip off or I am missing info casch vs. Insurance?

Posted by: Karen L Eoppolo in Wilmington, DE. Posted: March 7th, 2021 04:03PM
Type of Test: Stool

Why would stool sample test cost over $700 after insurance claim? Outrageous! What the blank is going on with healthcare when I’m paying for health coverage and still being charged this amount for a poop test?

Posted by: Remmy6981 in Bartonsville, PA. Posted: May 1st, 2020 07:05PM
Type of Test: Comprehensive stool sample

Rip off. Costa less at the vet

Posted by: Sheree in Ruidoso, NM. Posted: July 19th, 2019 07:07AM
Type of Test: Fecal bacteria

I was shocked when I got billed for over $500.00 for one test. This lab ripped me off, and my doctor never informed me of the possible cost.

Posted by: in Rochester, NY. Posted: May 24th, 2019 10:05AM
Type of Test: ladna-dna/rna problem tq 6-11, clostridi

500 of the bill was simply for the la dna/rna probe tq 6-11 which supposedly checks for a multitude of issues (from my chart it looks like six) I was not expecting this type of bill!! Totally caught off gaurd

Posted by: Macat in Abilene, TX. Posted: February 27th, 2019 07:02PM
Type of Test: Stool comprehensive panel

It is incredible that hospital covered so much money for a lab test that must be cheaper than 100 $. Health insurance negotiated with the hospital to pay 925 $ and at the end I paid 550 $ for the deductible. Anyway, crazy amount of money for this test!

Posted by: danadear in Gastonia, NC. Posted: March 13th, 2018 07:03AM
Type of Test: fecal stool test

Ordered to rule out cdiff. This was a ridiclas amount charged and have yet to find anyone that has paid as much.

Posted by: Charles KNOBLAUCH in Hoffman estates, MN. Posted: February 6th, 2018 11:02AM
Type of Test: Stool culture


Posted by: MMartini in Carlsbad, NM. Posted: January 11th, 2018 07:01PM
Type of Test: Stool culture

I cannot believe the amount I have been charged for a stool test. I am furious and I have no idea on how Im going to pay for it.

Posted by: RogerCA in Lafayette, LA. Posted: February 10th, 2015 05:02AM
Type of Test: Stool Culture

I feel I was seriously ripped off as others have been by the insurance/medical collaboration. When I got my bill that the insurance company covered only about $700 I was floored, but already committed. Veterinarians perform very similar tests for about $100. I am going to see if I can get the same results through other labs for less and post here. I hope others do the same.

Posted by: larryr in aurora, CO. Posted: May 31st, 2013 08:05AM
Type of Test: stool

Lactoferrin $304, Metabolic panel $583, lipase $377, culture $370, campylobacter $121, e coli $121, again e coli $497, again e coli 497, dif tox $383 O&P $333 another O&P 393 all on ONE stool sample. total of $4200 for one stool sample

Posted by: Stockton Mike in Stockton, CA. Posted: October 1st, 2012 06:10PM
Type of Test: Stool lab test

I went to San Joaquin General Hospital in French Camp C.A. and all they did was take a stool sample and my bill is $2,104.00 plus another $415.00 physician fee. Is this price right? They said they would call me four days later if there was a problem and I was fine two days later so I felt no need to call them and was happy they didn’t call me. This bill however seems beyond ridiculous to me.

Posted by: TomW in Columbus, IN. Posted: June 29th, 2012 11:06AM
Type of Test: Stool lab test

Please help me to see if these charges are normal for just a stool lab test:rnClostridium Diff Toxin Test $230rnCryptonsporidium AG $169rnGiardia Lamblia $169rnOva and Parasites Stool $165rnRotavirus $284rnStool Culture $37rnAditional Stool Pathogens $52rnCampylobacter EIA $52rnTrichrome Stain $109rnEscherechia Coli 0157 Antigen $73rnrnIf not normal, what is the normal range? External Resources:

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How is Cologuard billed?

Cologuard is only billed under CPT code 81528.

How much does guardant shield cost?

Three years, 20,000 participants and untold millions of dollars, and the pivotal trial of Guardant’s Shield colorectal cancer screen has turned out a disappointment. Approval is still probable, and even widespread reimbursement for the blood test is on the cards, but the label is likely to be narrower than hoped for.

Guardant’s shares were down 31% in early trade today, slicing $1.3bn off its market cap. The misfire means Exact Sciences will remain the leading colorectal cancer screening company, thanks to its faecal test Cologuard. Relieved shareholders sent Exact’s stock up 26%, adding nearly $2bn to its market value.

The Shield assay is already sold in the US as a lab-developed test, without FDA oversight. The Eclipse study was intended to secure approval and thus reimbursement of the test, thereby expanding its sales. Eclipse recruited a vast number of people with no colorectal cancer diagnosis and an average risk of developing the disease.

  • It tested two versions of Guardant’s liquid biopsy – a cell-free DNA (cfDNA)-only test and an assay using both cfDNA and protein biomarkers.
  • The cfDNA-only test outperformed the version with protein biomarkers, and the company only revealed data on the better version.
  • Compared with the gold standard diagnostic method, colonoscopy, Shield, previously known as Lunar-2, detected colorectal cancer with 83% sensitivity.

Specificity was 90% in people without advanced neoplasia and in those a who had a negative colonoscopy result. This is a decrease from previous trial results; in data presented at at last year’s Asco the assay yielded sensitivity and specificity of 91% and 94%, respectively.

  1. The data cited on Cologuard’s label puts Exact’s test’s sensitivity and specificity at 92% and 87%, respectively.
  2. Second fiddle It gets worse for Guardant.
  3. The test only demonstrated 13% sensitivity in detecting advanced adenomas – benign tumours that can go on to become cancerous.
  4. Cologuard’s sensitivity here was 42%.

This is the real disappointment, as it might prompt the FDA to omit a claim for advanced adenomas in any label it grants Shield. Alternatively, the agency could mandate that the test only be used once other colorectal cancer screening methods have been refused.

Approval in at least some part of the screening population is fairly likely. If it does come Medicare reimbursement is all but assured, since the trial results exceed the performance criteria set forth by the Centers for Medicare & Medicaid Services. These call for at least 74% sensitivity and 90% specificity.

Guardant will complete its premarket approval submission to the FDA in the first quarter of 2023, and is targeting approval around a year later, according to SVB analysts. It hopes to be able to price the test at $895. Guardant reckons the CRC screening market to be worth $20bn, and SVB analysts see liquid biopsies reaching a market share of around 10% of that.

Following yesterday’s data, they believe Shield could obtain 40% within that, meaning it could eventually see annual sales of around $800m. By contrast, the sellside forecasts sales of $1.3bn for Cologuard this year, rising to $3.2bn in 2028, consensus data from Evaluate Medtech shows. The Eclipse readout might yet prompt analysts to raise this figure.

No wonder Exact is riding high.

Who provides Cologuard?

Exact Sciences (company)

Innovation One, the headquarters of Exact Sciences in Madison, Wisconsin (2020).
Products Cologuard, Oncotype DX, Oncotype MAP
Revenue US$2.08 billion (2022)
Operating income US$−594 million (2022)
Net income US$−624 million (2022)