Cologuard® Update (CPT 81528)
Posted on September 27, 2019
Effective 1/1/20, one of our self-funded employer groups, Baystate Health, will be covering 100% of the cost of the Cologuard test for their employees and NO prior authorization is needed.
As a provider, you will need to see your patient’s member ID card to know if a prior authorization is needed prior to ordering the test.
- Baystate Health employees will have the following group numbers; and the claim can be submitted to Health New England without involving eviCore for approval.
- S03004 – BH Silver HMO
- S03032 – BH Gold PHCS PPO
- S03033 – BH Advantage PPO
- S03053 – BH HSA Medical PPO
As a reminder, all other Commercial and BeHealthy Partnership members require a proir authorization through eviCore before ordering the test.
Effective 1/1/20, our Medicare Advantage members will also require a prior authorization through eviCore before ordering the test.
For more information, please call Provider Relations at (800) 842-4464, ext. 5000, or send an email to providerrelations@hne.com.
