Amended Medical Policy

Medical Policy Number	Medical Policy Name	Effective Date of Change	Description of Changes
BI062	Preventive Health Benefit	04/01/17	Updated to allow virtual colonoscopy with pre-authorization. Added that Cologuard and Epi proColon tests will not be covered.

Note: Recent studies have shown that Cologuard has no added advantage, and Epi proColon test has low sensitivity for detecting cancer compared to other available colon cancer screening tests. Therefore, coverage is discontinued for both tests under preventive or medical benefit.

1704 CR 014

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