Insurance & Billing FAQs
We realize healthcare can be a large expense and that coverage can be complicated. We’re available by phone 24 hours a day, 7 days a week at 1-844-870-8870 to help you if you have any questions not answered below.
We highly recommend that you call your insurer directly to confirm what they will pay, what they expect you to pay, and if you or your doctor need to file any paperwork (like a prior authorization) before you use the test. You can tell them Cologuard is billed under CPT code 81528
Many Plans Cover Cologuard
For a reference sheet of plans that cover Cologuard, click here. Plans are listed by geographic region, and this list is updated monthly.
Please click below for more information on each type of plan. New plans are added frequently, so check back for updates.
Patients with Traditional Medicare and Medicare Advantage plans do not have any co-pays or deductible amounts.
For Medicare Advantage patients, this became effective June 15, 2016.
- Private Insurance
Depending on your insurer and specific plan, your out-of-pocket cost for Cologuard could range from $0 to $649 (as of July 2016).
The following insurance plans may cover all or part of your Cologuard test:
- Aetna Medicare Advantage
- Anthem Blue Cross & Blue Shield
- Blue Cross & Blue Shield Federal Employee Program
- Government Employees Health Association (GEHA)
- Anthem Blue Cross & Blue Shield of Virginia
- CareFirst Blue Cross & Blue Shield
- Horizon Blue Cross & Blue Shield of New Jersey (Medicare Advantage)
- Johns Hopkins Employee Health Plan
- Medical Mutual of Ohio
- Optima Health (Medicare Advantage)
- Oxford Health Plans, a UnitedHealthcare Co. (NJ only)
- The Alliance
- Anthem Central Region (OH, IN, KY, MO, WI)
- Arise Health Plan/WPS Health Insurance
- BlueCross BlueShield of Illinois
- Blue Cross & Blue Shield of Minnesota
- Dean Health Plan
- Group Health Cooperative of Eau Claire
- Group Health Cooperative of South Central Wisconsin
- Health Tradition Health Plan
- The Ohio State University Health Plan
- Physicians Plus
- Prevea360 Health Plan
- Priority Health
- Security Health Plan
- Unity Health Plan
- Wellmark Blue Cross and Blue Shield
- 1199 SEIU United Healthcare Workers East
- Blue Cross & Blue Shield of Massachusetts
- Blue Cross & Blue Shield of Rhode Island
- Blue Cross Blue Shield of Western New York
- Excellus Blue Cross & Blue Shield
- Geisinger Health Plan
- Independence Blue Cross
- Tufts Health Plan
- Univera Healthcare
- UPMC Health (Medicare Advantage)
- Anthem Blue Cross & Blue Shield of Georgia
- Blue Cross & Blue Shield of Florida
- Blue Shield of Louisiana
- HealthChoice/Orlando Health
- Rosen Medical Center
- Access Medical Group, Inc. – HMO
- Anthem Blue Cross California - PPO
- Arizona Health Care Cost Containment System
- Asuris Northwest Health
- BlueCross BlueShield of Arizona
- BlueCross BlueShield of Kansas
- BlueCross BlueShield of Idaho
- BlueCross BlueShield of Montana
- BlueCross BlueShield of New Mexico
- BlueCross BlueShield of Oklahoma
- BlueCross BlueShield of Texas
- Bridgespan Health Insurance (OR, WA, UT, ID)
- Brown & Toland Physicians – HMO
- Facey Medical Group – HMO
- Health Net
- Meritage Medical Network – HMO
- New Mexico Health Connections
- PacificSource Health Plans
- Premier Care IPA – HMO
- Providence Health Plan
- Quad City Community Healthcare
- Regence Blue Cross & Blue Shield (OR, UT)
- Regence Blue Shield (WA, ID)
- Rocky Mountain Health Plan
- SanSum Clinic - HMO
- SelectHealth Advantage
- Seoul Medical Group – HMO
We are seeking to have Cologuard covered by plans not listed here as soon as possible.
Medicaid coverage varies by state. Whether you’re enrolled in standard Medicaid or a Medicaid managed care plan can also affect your coverage.
For details, please call your plan provider. The number is on the back of your insurance card.
- Are there any Medicare criteria I need to meet to be covered?
- Are there any co-pays to Medicare patients?
Private Insurance FAQs
- Is this test covered by my insurance? How can I find out?
- How do I ask my insurance company about coverage for Cologuard?
- What if my insurance company tells me it won’t cover Cologuard?
- Why did I get a bill from Exact Sciences Laboratories?
- Why didn’t my insurance pay this claim?
- If my insurance company denies a claim, can I appeal?
- I've heard plans in my states are required to cover Cologuard. What does that mean?
All Other FAQs
- How much does this test cost?
- What methods of payment are accepted?
- What are the CPT, HCPCS, and ICD-10 Codes for Cologuard?