Closing Gaps in Colon Care

March 12, 2024

Adults ages 45 to 75 should have preventive screenings to reduce their risk of colorectal cancer, according to the U.S. Preventive Services Task Force and Centers for Disease Control and Prevention. Colorectal cancer is becoming more common in people younger than 55. We encourage you to discuss colon health and screening options with our members. We’ve created resources for members to help.

Recommended Screening

USPSTF recommends screening with any of the following tests for adults ages 45 to 75:

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

See our preventive care guidelines for more information about screening. Providers may want to discuss earlier testing with members with a family history of colorectal disease or other risk factors.

Closing Care Gaps

Colorectal Cancer Screening is a Healthcare Effectiveness Data and Information Set (HEDIS®) measure that tracks appopriate screenings for adults age 45 to 75. To help close gaps in our members’ care, consider these tips:

  • In our members’ medical records, document the date a colorectal cancer screening is performed or include the pathology report indicating the type and date of screening.
  • Encourage members to stay up-to-date on their screenings as well as all screening options available.
  • Reach out to members who cancel screenings and help them reschedule.

Checking Eligibility and Benefits

Check member eligibility and benefits using Availity® Essentials 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.

For most of our members, preventive colorectal cancer screening is covered at no cost share. For diagnostic tests for colorectal cancer, our members may have out-of-pocket costs. This includes diagnostic tests for members who have signs of health problems or a family history of disease. Learn more.

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 Blue Cross and Blue Shield of Montana.

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 member contract or member guide 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 BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.

HEDIS is a registered trademark of the National Committee for Quality Assurance.