New Guidance from Administration Helps Ensure Coverage for Follow-up Colonoscopies, Will Save Lives from Colon Cancer 

January 11, 2022

WASHINGTON D.C. – New guidance from the Tri-Agencies (Department of Labor, Department of Health and Human Services, Treasury) announced late Monday says private insurance plans must now cover follow-up colonoscopies after a positive non-invasive stool test. To date, colonoscopies after positive stool tests are often considered “diagnostic” and, therefore, not covered in full the way a preventive screening is required to be covered by the Affordable Care Act. While this new guidance will expand coverage of follow-up colonoscopies to many more individuals nationwide, including individuals who have coverage through Medicaid expansion, it does not apply to traditional Medicaid and Medicare plans. The following is a statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). 

“The announcement from the Tri-Agencies clarifying all private insurance plans must fully cover colonoscopies after a positive non-invasive stool test will save lives from colon cancer. Ensuring individuals have access to this lifesaving screening will significantly reduce suffering and death from this disease. This year alone, the American Cancer Society estimates more than 150,000 individuals will be diagnosed with colorectal cancer and more than 52,000 will die from the disease. But colorectal cancer is preventable when pre-cancerous polyps are found and removed through a colonoscopy. 

“ACS CAN and its partners have been urging the administration to clarify this coverage requirement and we are very pleased this action has been taken. ACS CAN will work to expand this coverage to traditional Medicare and Medicaid beneficiaries to help ensure all individuals who need a colonoscopy are able to access one.”  

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