Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

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.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


Improvements to the Corrected Claim and Second-Level Appeals Processes

Home Base Offers Resources and Trainings for Treating Veterans


Updated Policy: Fecal DNA Testing for Colorectal Cancer

New Coverage Reflects Importance of Advance Care Planning

Updated Policy: Vaccine and Immunization

New Policy: Monitored Anesthesia Care for GI endoscopy

Prior Authorization Required for Lipitor

Synagis for Upcoming RSV Season

Anxiety and School Refusal in Children


Reminder for Medicare Providers: Sign Up to Use the Stride Portal

Bill Diagnosis Codes in the Primary Position for Preventive Services


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator