Colorectal Cancer Screening for Members Age 45 to 75

In line with new U.S. Preventive Services Task Force (USPSTF) recommendations, Blue Cross and Blue Shield of Texas (BCBSTX) recommends that colorectal cancer screening for our members begin at age 45 rather than 50. We are updating our Preventive Care Guidelines and our claims processing to reflect this change. Screening should continue until age 75.

Why Screening Is Important

Colorectal cancer is the third leading cause of cancer-related deaths in the U.S., according to USPSTF . New cases among adults younger than 50 are increasing. Colon cancer usually has no symptoms in its early stage. Screening before symptoms present themselves can catch the disease when treatment is most effective.

Recommended Screening

USPSTF recommends screening with any of the following tests for members age 45 to 75:

• Annual guaiac fecal occult blood test (gFOBT)
• Annual fecal immunochemical testing (FIT)
• DNA-FIT every one to three years
• Flexible sigmoidoscopy every five years
• Flexible sigmoidoscopy every 10 years with annual FIT
• Computed tomography (CT) colonography every five years
• Colonoscopy every 10 years

Providers may want to discuss earlier screening with members with a family history of colorectal disease or other risk factors. We encourage providers to discuss colon health with all members.

Checking Eligibility and Benefits

For most of our members, colorectal cancer screening is covered at no cost share. Check member eligibility and benefits using Availity^® Provider Portal or your preferred vendor before every scheduled appointment. Eligibility and benefit quotes include members’ coverage status and other important information, such as applicable copays, coinsurance and deductibles. Ask to see members’ ID card and photo ID to guard against medical identity theft.

Some screenings involve a member’s pharmacy benefits in addition to their medical benefits, such as the prep kit for colonoscopies. For details about pharmacy benefit coverage, call the number on the member’s ID card. A member’s pharmacy benefit may be managed by a company other than BCBSTX.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.