← All guides

Does Medicare cover Cologuard (the stool DNA test)?

Yes. Medicare Part B covers the multi-target stool DNA test, the test sold as Cologuard, once every 3 years at no cost to you when the provider accepts assignment, as long as you are between 45 and 85, have no symptoms of colorectal disease, and are at average risk. If the result is positive, Medicare covers the colonoscopy that follows as a screening test.

This page is about the stool DNA test. For how often Medicare pays for blood work and the other screening tests, see our free chart of Medicare's screening schedules.

What the test is

Medicare calls it a "multi-target stool DNA" test. The billing code Medicare's provider chart lists for it, CPT 81528, describes it as "Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers ... utilizing stool, algorithm reported as a positive or negative result." In plain words: a laboratory looks at a stool sample for a set of DNA markers, and the answer comes back as positive or negative. Medicare.gov's page does not use a brand name; Cologuard is the product this description fits, and CMS's June 2026 decision memo names Cologuard Plus by name.

Who qualifies

Medicare.gov lists three conditions, and you have to meet all of them: "You're between 45-85," "You show no symptoms of colorectal disease," and "You're at average risk for developing colorectal cancer."

The national coverage rule, NCD 210.3, spells out what those words mean. No symptoms means "no signs or symptoms of colorectal disease including but not limited to lower gastrointestinal pain, blood in stool, positive non-invasive biomarker colorectal cancer screening test." Average risk means "no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease" and "no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer." The rule also says you must be "Provided with information about the test performance and the importance of a follow-on colonoscopy if the test returns a positive result."

Medicare's provider chart puts the same three conditions in three words: "Aged 45–85 years / Asymptomatic / At average colorectal cancer risk."

How often Medicare pays

Medicare.gov: "Every 3 years." The provider chart: "Once every 3 years." The national coverage rule uses the same interval: "covered once every 3 years."

What you pay

Medicare.gov: "You pay nothing for these tests if your doctor or other health care provider accepts assignment." The provider chart says the same from the billing side: "No copayment, coinsurance, or deductible."

If the test is positive

Medicare.gov: "If you get a positive result after a multi-target stool DNA screening test, Medicare also covers a follow-up colonoscopy as a screening test." Medicare.gov's colonoscopy page gives the cost: "If your doctor or other health care provider accepts assignment, you pay nothing for the screening test(s), including follow-up colonoscopies you get after a positive result from a Medicare-covered blood-based biomarker test or non-invasive stool-based test."

CMS's June 2026 decision memo explains the reasoning: "The follow-on colonoscopy after a positive non-invasive stool-based or blood-based CRC screening test is considered a complete CRC screening" and "is not subject to cost sharing." In other words, the stool test and the colonoscopy that follows it count as one screening.

One thing does cost money. If a polyp or other tissue is removed during that colonoscopy, Medicare.gov says you pay "15% of the Medicare-approved amount." Our colonoscopy guide explains that rule and the schedule under which the percentage goes down in later years.

The code on the claim

In one line: CPT 81528 is the multi-target stool DNA screening test, and Medicare's provider chart also lists 0464U under the same rule.

What changed in June 2026

Medicare's rule for these tests, NCD 210.3, was rewritten. The new version says "Effective Date of this Version 06/08/2026" and "Implementation Date 01/04/2027." Until then, the previous version, which was in force from January 1, 2023 to June 8, 2026, had one section for the stool DNA test and a separate one for the blood test. The new version replaces both with a single section called "Non-Invasive Biomarker Tests."

Under that section, a test is covered when it is "FDA market authorized and indicated for colorectal cancer screening," when it meets "the requirements of the FDA-required post-approval study," when it is "processed in a CLIA certified laboratory," and when it can "meet EITHER Criteria 1, a sensitivity of greater than or equal to 90% and a specificity greater than or equal to 87%, OR Criteria 2, a sensitivity of greater than or equal to 79% and a specificity of greater than or equal to 90% in the detection of colorectal cancer compared to the recognized standard (accepted as colonoscopy at this time), based on the FDA labeling." Those two percentages are the rule's measure of how well a test performs, in its words, "in the detection of colorectal cancer" when compared against a colonoscopy.

For the reader, the parts that matter did not move. The new section still says "Age 45 to 85 years," still requires that you be "Asymptomatic" and "At average risk," and still says the tests "are covered once every 3 years." The rule itself does not name any product, list any billing code, or say what you pay; those come from medicare.gov and the provider chart quoted above.

The decision memo behind the new rule, CAG-00440R dated June 8, 2026, gives Cologuard Plus "93.9% sensitivity" and "92.7% specificity," which is above both numbers in Criteria 1. CMS has since told its claims contractors, in MLN Matters MM14581 dated August 27, 2026, that they "will accept and pay for the CRC screening test (ColoSense™) using CPT code 0421U as a covered service," a second test paid under the same rule.

What the Preventive Services Task Force says

The U.S. Preventive Services Task Force's May 18, 2021 recommendation grades colorectal cancer screening by age: Grade B for ages 45 to 49, Grade A for ages 50 to 75, and Grade C for ages 76 to 85. On this test in particular it says "screening every 1 to 3 years with sDNA-FIT would be reasonable." That is a recommendation about screening in general. Medicare's payment rule is the once-every-3-years limit quoted above, and this page does not say whether the test is right for you.

If you have Medicare Advantage

A plan can have its own rules about which lab you use and whether the order needs approval first. For what can and cannot change under a plan, see Medicare Advantage and lab tests.

Before you go

This is ClaraCover's checklist, built from the rules above.

1. Are you between 45 and 85, with no symptoms? Those are the first two of Medicare's three conditions. The third is average risk, which means none of the personal or family history listed above. If you have that history, this test is outside the rule, and a different screening may apply; your doctor's office can tell you which.
2. When was your last colorectal screening of any kind? This test is paid once every 3 years. Have the date of your last stool test, blood test, or colonoscopy ready when the office orders it.
3. If it comes back positive, the colonoscopy is a screening. Medicare covers it as a screening test at $0 with assignment. If the office books it as anything else, ask why.

Sources

• Medicare.gov: Multi-target stool DNA tests
• Medicare.gov: Colonoscopies
• CMS: Medicare Preventive Services educational tool (MLN006559, July 2026), Colorectal Cancer Screening Tests entry
• CMS: National Coverage Determination 210.3, Colorectal Cancer Screening Tests (version 8, effective June 8, 2026)
• CMS: National Coverage Determination 210.3, version 7 (in force January 1, 2023 to June 8, 2026)
• CMS: Decision Memo CAG-00440R, Colorectal Cancer Screening Tests (June 8, 2026)
• CMS: MLN Matters MM14581, National Coverage Determination 210.3, Colorectal Cancer Screening Tests, Non-Invasive (August 27, 2026)
• U.S. Preventive Services Task Force: Colorectal Cancer, Screening (May 18, 2021)

Checked September 27, 2026. This page explains published Medicare rules. It is not medical or insurance advice, does not say who should have this test, and cannot tell you whether your own test will be covered or what your bill will be; your doctor's office and Medicare can. ClaraCover has no relationship with any test maker, provider, or plan.