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TO:  Physicians, Independent Laboratories, Independent Radiology, Hospitals, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

RE:   Noninvasive Colorectal Cancer (CRC) Screening

Effective October 1, 2025, the Alabama Medicaid Agency (Medicaid) added coverage for the following noninvasive colorectal cancer (CRC) screening: CT colonography and Cologuard. Medicaid will cover these codes in accordance with the United States Preventative Services Taskforce (USPSTF) recommendation.

CT Colonography (HCPCS Code 74263)

Medicaid will cover CT colonography when ordered by a treating physician and for patients who meet these criteria:

·        Age 45 to 75

·        Asymptomatic 

·        Limited to once every 5-year

Cologard (HCPCS Code 81528)

Medicaid will cover the Cologuard test when ordered by a treating physician and for patients who meet these criteria: 

·        Age 45 to 75

·        Asymptomatic 

·        Limited to once every 3-year  

Providers with billing questions may contact the Gainwell Technologies Provider Assistance Center at 1-800-688-7989.

     The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2025 American Medical Association 
     and © 2025 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.