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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

September 2016

Updated Policy: Fecal DNA Testing for Colorectal Cancer


Harvard Pilgrim recently updated our Fecal DNA Testing for Colorectal Cancer Medical Policy to be consistent with recommendations by the United States Preventive Services Task Force (USPSTF). The policy now incorporates age-based restrictions.

Effective for dates of service beginning November 16, 2016, Harvard Pilgrim considers fecal DNA testing medically necessary for colorectal cancer screening once every three years for members:

  • Age 50 to 75 years
  • Age 76 to 85 years upon individual consideration, taking into account the member’s overall health status and prior screening history

Harvard Pilgrim does not cover fecal DNA testing for members age 49 and under; members who have symptoms of colon cancer; or members who have had a colonoscopy in which polyps were detected. In addition, Harvard Pilgrim considers all other forms of fecal DNA testing for colorectal cancer investigational and experimental.

For more information, please refer to the updated Fecal DNA Testing for Colorectal Cancer Medical Policy.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator