A colonoscopy is a medical procedure in which a physician uses a scope to examine the inside of your rectum and colon. This examination can identify any ulcers, swollen tissues, polyps, or cancerous tissues that may be present. These procedures are quite invasive and require the patient to be sedated and placed under anesthesia. Cologuard provides an alternative option that allows for the detection of colorectal cancer, and Medicare benefits may include coverage for this product.
What is Colorectal Cancer?
Colorectal cancer is one of the main conditions physicians look for during colonoscopy examinations. Colorectal cancer can be found in both the colon and rectum, and these two cancers are often combined due to the similarity in symptoms.
Cancer arises when a group of cells is not able to be regulated and is permitted to continue to duplicate, expand, and spread. This can occur in almost any area of the body, and once the growth becomes large enough, it may be transferred to other areas of the body as well.
Colorectal cancer often arises from the formation of polyps on the inner lining of the rectum or colon. Polyps are small growths that can expand and become cancerous over time. A polyp size of greater than one centimeter or the formation of multiple polyps signifies an increased risk of cancer occurring.
Many types of cancer can occur in the rectum and colon, including adenocarcinomas, gastrointestinal stromal tumors, carcinoid tumors, sarcomas, and lymphomas. Each of these cancers behaves differently and is found in different locations in the digestive tract.
What is Cologuard?
Cologuard is a detection tool used to evaluate fecal matter and to determine whether colorectal cancer is present in the sample. This device can be used by any individual over 50 years of age that is potentially at risk of being diagnosed with this type of cancer. To use this device, you must also show no signs or symptoms of this cancer and have a clean family history in its regard.
Cologuard requires only a solid stool sample and is not invasive like normal colonoscopy procedures. After the fecal sample is collected, a DNA test evaluates whether or not blood and specific DNA mutations are present in the sample. Certain markers can note whether or not polyps have formed in the digestive tract.
However, it is important to note that Cologuard should not be used by individuals who are at a high risk of developing colorectal cancer. Increased risk could be due to personal or family history of this disease. A past diagnosis of adenomatous polyps or inflammatory bowel disease can also increase risk of cancer development. The Cologuard test is not designed to replace the colonoscopy, and any findings that indicate poor digestive tract health should be followed up with a normal colonoscopy examination.
What Medicare Coverage Options are Available for Cologuard?
Medicare includes coverage for colorectal cancer screening, including a Cologuard kit under specific circumstances. A stool DNA test (Cologuard) will be covered by Medicare every 3 years for people 50 to 85 years of age who do not have symptoms of colorectal cancer and who do not have an increased risk of colorectal cancer. Most Medicare plans allow recipients to obtain these tests without the need for copayments or coinsurance, and the deductible will not apply. It is important to note that you will need to get Cologuard prescribed through your doctor in order for your Medicare coverage.
Services Covered by Medicare Part A & Part B