frequently
asked questions

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How to get screened with Cologuard

How can I get screened with Cologuard? Who prescribes this test?

Cologuard is available by prescription only and must be ordered by your healthcare provider. Typically, you would discuss screening with your primary care physician, nurse practitioner, physician assistant or other healthcare provider as part of a regular wellness appointment. Cologuard cannot be purchased over the counter. If your healthcare provider would like to know more about Cologuard, please have them contact Exact Sciences Laboratories at 1-844-870-8870.

Is Cologuard available in all U.S. states?

Cologuard was approved by the FDA on August 11, 2014, and is available in all U.S. states and territories. As of October 9, 2014, Exact Sciences Laboratories is licensed in New York state. If you have more specific questions, please contact us at 1-844-870-8870.

Currently, Cologuard is only available in the United States.

About Cologuard & Stool DNA Technology

What is Cologuard?

Cologuard is an easy to use, noninvasive colon cancer screening test that you can use in the privacy of your own home. It identifies altered DNA and/or blood in stool, which are associated with the possibility of colon cancer or precancer. Your healthcare provider will talk with you about your results. For more about understanding results, click here.

How do you get DNA out of stool?

DNA is continuously shed from cells in the intestinal lining, where it is passed into the stool. If cancer or precancer is present, abnormal cells will shed into the colon and stool along with normal cells. We use a molecular biology process to capture specific pieces of DNA for further analysis. 

Why does Cologuard use stool samples and not blood samples?

DNA is continuously shed from cells in the intestinal lining and passed into the stool. Both precancer and cancer shed DNA, so it can be an early indicator of the presence of colon cancer or precancerous lesions, before altered DNA would be present in the blood stream.

Is Cologuard a genetic test?

No. Cologuard is not a test to confirm or deny a suspected genetic condition, or help determine a person's chance of developing or passing on colon cancer. Cologuard does not provide information about DNA changes that are inherited or can be passed on to your children. Cologuard identifies DNA mutations that are acquired over time in cells lining the colon; these mutations can be associated with the presence of colon cancer or precancerous lesions.

How was Cologuard developed?

Cologuard was developed by Exact Sciences in collaboration with researchers at the Mayo Foundation for Medical Education and Research. It went through extensive research and development, including a clinical study of 10,000 average risk study participants that validated the test's safety and efficacy in screening for colon cancer and precancer.

Is Cologuard FDA approved?

Yes, Cologuard was approved by the FDA in August 2014 after undergoing a rigorous review process known as a Pre-Market Approval (or PMA).

How effective is Cologuard?

In a clinical study of 10,000 participants of average risk for colon cancer, Cologuard found 92% of cancer. Cologuard was negative in 87% of participants without cancer or advanced precancerous lesions.

Should colonoscopy be used in addition to Cologuard?

Cologuard is a screening test. Any positive result should be discussed with your healthcare provider and followed by a diagnostic colonoscopy.

How often should Cologuard be used?

Cologuard is covered by Medicare every 3 years for average risk patients between the age of 50-85. Cologuard is recommended every 3 years by the American Cancer Society. 

Colon cancer screening guideline recommendations vary for people over the age of 75. The decision to screen people over the age of 75 should be made in consultation with a healthcare provider. The rate of false positive Cologuard results increases with age. Talk to your healthcare provider about what screening program is appropriate for you.

Is Cologuard included in the United States Preventive Services Task Force (USPSTF) guidelines? What does this mean?

Yes, Cologuard is included in the United States Preventive Services Task Force (USPSTF) guidelines on colon cancer screening as of its June 2016 update. The USPSTF strongly recommends colon cancer screening for people aged 50-75 (‘A’ rating), meaning the committee finds a substantial net benefit in colon cancer screening.

Cologuard is included on equal standing among the other 'A rated' colon cancer screening options, including colonoscopy, CT colonography, flexible sigmoidoscopy, flexible sigmoidoscopy with FIT, gFOBT, and FIT. Read the USPSTF’s guidance on colon cancer screening in full by visiting its website.

Is Cologuard included in the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures? Why does this matter?

Yes, Cologuard is included in the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for colon cancer screening as of 2016. HEDIS is a helpful tool used by more than 90% of health plans in America. The quality measures analyze the performance of healthcare services and care. The data and results are used to make improvements in the healthcare provider's quality of care and service.

Who Can Be Screened with Cologuard? Who Cannot?

Who can get screened with Cologuard?

Cologuard is approved for use by men and women, 50 years of age and older, who are at average risk for colon cancer. 

Cologuard is not for everyone. It is not a replacement for diagnostic or surveillance colonoscopy in high-risk individuals. You may be a high-risk individual if:

  • You have a personal history of colon cancer, polyps, or other related conditions (adenomas, IBD, or Crohn's Disease)
  • You have a family history of colon cancer (one or more relatives diagnosed with colon or rectal cancer before the age of 60, or two or more first degree relatives diagnosed with colon or rectal cancer of any age)
  • You have had a positive result for another colon cancer screening method in the last six months

Cologuard must be prescribed by a licensed healthcare provider and cannot be purchased over the counter.

For complete information on Cologuard, please click here.

If one of my family members had colon cancer, is this test right for me?

Cologuard is approved for use by adults 50 years of age and older, who are at average risk for colon cancer. Please discuss your overall screening plan with your healthcare provider to determine what is right for you.

Can I use Cologuard if I have hemorrhoids, menstrual period or blood in the stool?

Cologuard should not be used by those who have or may have blood in their stool due to actively bleeding hemorrhoids, menstruation, or other existing conditions, as this may result in a false positive result. Please discuss your overall screening plan with your healthcare provider to determine what is right for you.

If I have mobility issues, will I have a problem with the test?

Collecting a sample for Cologuard involves sitting on a toilet and having a bowel movement, as well as opening bottles and containers. If you typically need assistance using the bathroom or opening containers, you may need assistance while collecting the sample.

Preparing for the Test

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.

Shipping

What comes in the test kit? Where will I get it?

After our lab receives the completed order from your healthcare provider, we will send the Collection Kit to the address provided. We may need to contact you ahead of shipment if any information is missing. Once you receive the Collection Kit, it will include instructions for collecting a sample, a prepaid return shipping label, and Exact Sciences Laboratories phone number, in case you have any additional questions.

Can Cologuard be taken in my healthcare provider's office?

We deliver the collection kit to your home address, so you can collect a sample privately and easily. If you prefer to collect your sample at your healthcare provider's office, please contact him or her to see if he or she can accommodate your request.

What if I don't have a permanent address?

We need an address where you can receive the kit, but it doesn’t need to be your permanent address.

Can Cologuard be mailed to a PO Box?

Yes. Although we would prefer to ship a kit to your physical address, we can send your kit via UPS to your PO Box if that is where you normally receive packages. Please note you will still need to contact UPS to schedule a pickup or drop your sample off at a UPS location, once you have collected your sample.

How should I send the collection kit back to the lab?

The Collection Kit (with the sample inside) should be mailed back to our lab via UPS, using the original box and prepaid and pre-addressed return label that we provide.

You can drop off the kit at any UPS store or shipping location, or you can call 1-800-PICKUPS 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 it Monday through Thursday for this reason.

If I schedule a UPS pick-up, do I need to be home at that time?

No, you do not need to be at home at the pick-up time if you leave the shipping box in an easy-to-see location, such as near the front door. 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 it Monday through Thursday for this reason.

Collecting Your Sample

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 received a kit but I made a mistake collecting my sample. 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 your sample can still be used or 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.

How will I know if my sample is "normal"?

It is most important to get a 'typical sample' for you.  For example, if you normally have loose stool, go ahead and take the test. If you do not normally have loose stool, it is best to wait until the stool returns to its normal consistency. 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. 

Understanding Your Results

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.

What does a positive result mean? A negative result?

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 precancer. False positive and false negative result occur with Cologuard and appropriate follow-up is important. Patients with a positive result should have 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.

A negative result means that Cologuard did not detect significant levels of DNA and/or hemoglobin biomarkers in the stool which are associated with colon cancer or precancer. 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.

Insurance & Billing - Medicare

Are there any Medicare criteria I need to meet to be covered?

Patients for whom Cologuard is a covered service under Medicare or Medicare Advantage plans, should not have any co-pays, deductible payment, or out-of-pocket expense. For Medicare Advantage patients, prior authorizations may apply; please call your insurer to confirm. Medicare covers Cologuard once every 3 years as long as you are between 50-85 years old and you are at average risk for developing colon cancer. Medicare will not cover the test if you have symptoms that your healthcare provider thinks may be related to colon cancer, if you previously had a positive colonoscopy that found polyps or cancer, or if your healthcare provider determines that you have a high-risk family history of colon cancer.

Are there any co-pays or out-of-pocket expenses for patients insured by Medicare?

Patients for whom Cologuard is a covered service under Medicare or Medicare Advantage plans, should not have any co-pays or deductible amounts. For Medicare Advantage patients, prior authorizations may apply; please call your insurer to confirm.

Insurance & Billing - Private Insurance

How do I ask my insurance company about coverage for Cologuard?

We highly recommend that you call your insurer to ask whether your plan covers Cologuard and what if any out-of-pocket cost you may have prior to taking the test. Here are some useful tips to help you when you call your insurer: 

Before You Call

  • Look at the back of your insurance card to find the customer service or member services phone number.
  • Be ready to give your full name, date of birth, and member ID number (on front of card).

During Your Call

  • Ask these things:
    • Does my plan cover the Cologuard test? This service is billed under CPT code 81528. Is Exact Sciences Laboratories a participating in-network provider for my plan?
    • Do I have Preventive Care Services and colon cancer (CRC) screening included in my benefit plan? Is Cologuard an approved CRC screening option for me?
    • Is a prior authorization, statement of medical necessity, or any other documentation required from my healthcare provider? If yes, what information is needed?
    • What is my cost share for this service? Will I have any additional financial responsibility?
  • If you find out that Exact Sciences is out-of-network or that your plan doesn't cover Cologuard specifically, ask these additional questions:
    • Do I have out-of-network benefits and what will my financial responsibility be?
    • If Cologuard is not a covered benefit, how do I appeal this decision? What information does my healthcare provider or I need to provide?
    • How long will it take my healthcare provider or I to hear from you?
Why did I get a bill from Exact Sciences Laboratories?

The bill you received is for laboratory services provided by Exact Sciences Laboratories, for a screening test ordered by your healthcare provider, which you completed. This is separate from any services or bills you have for your healthcare provider's services.

The amount of the bill reflects the portion that your insurance company determined you were responsible for based on your benefit plan. If you have specific questions about your bill, please contact Exact Sciences Laboratories Customer Care Center at 1-844-870-8870 any time of day, 7 days a week.

Why didn't my insurance pay this claim?

You should have received an Explanation of Benefits (EOB) from your insurance company that explains in detail the services that were either paid or denied.  If you need further assistance concerning your EOB, please contact your insurance company directly.

If my insurance company denies a claim, can I appeal?

Yes, if you would like to appeal a denied claim, you can use our appeal letter generator tool to create a letter you can print and send to your insurer. 

I've heard plans in my state are required to cover Cologuard. What does that mean?

Patients should contact their insurance carrier to find out how the state mandate impacts their potential out-of-pocket costs. More than 30 states have legal mandates which require insurance companies to cover colon cancer screening tests like Cologuard for fully-insured patients.

As of October 1, 2017, these states include Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Illinois, Indiana, Kentucky, Maine, Maryland, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Washington, Washington D.C., Wisconsin and Wyoming.

Please note some plans are not included in these legal mandates (for example: self-insured plans).

All Other FAQs

How much does this test cost?

As of March 2017, the list price of Cologuard is $649. Insurance may cover some or all of that amount depending on the patient's insurance plan and benefits. We highly recommend that you call your insurer to ask whether your plan covers Cologuard and what if any out-of-pocket cost you may have prior to taking the test. You may also want to ask if there is any paperwork to file, such as a prior authorization, before using the test.

What methods of payment are accepted?

We accept personal check, Visa, Mastercard, Discover, American Express. You can also pay your bill online by clicking here.

Payments can be mailed to: Exact Sciences Laboratories LLC, Patient Pay, 27280 Network Place, Chicago, IL 60673-1272.

Please remember to include your payment stub and write your order number on the check. The order number can be found near the top of your bill.

What are the CPT, HCPCS, ICD-10 Codes, Tax ID, NPI, and Diagnosis Codes for Cologuard?

Cologuard is only billed under CPT code 81528. This code was established by the American Medical Association CPT Editorial Panel (and recognized by Medicare) with an effective date of 1/1/2016. It is also known as a HCPCS Level I or CPT Category I code.

Cologuard, Exact Sciences Laboratories Tax ID: 46-3095174

Cologuard, Exact Sciences Laboratories NPI: 1629407069

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