New Colon Cancer Test NOT on the Highmark Preventive Schedule

The Federal Drug Administration (FDA) has recently approved a blood test screening tool for colon cancer called “Shield” by Guardant Health. However, this new product has NOT been approved by the United States Preventive Services Task Force (USPSTF) and is NOT currently included on the Highmark Preventive Schedule. Our 2024 Preventive Health Guidelines and Immunization Schedules can be viewed here.

If Shield is ordered by a Highmark provider, members will be liable for cost share. The test costs approximately $895.

Also, this tool is NOT eligible to be used to close Healthcare Effectiveness Data and Information Set (HEDIS®) gaps.

Currently, there are only five procedures/tests that meet the HEDIS measure for Colorectal Cancer Screening:

  • Colonoscopy
  • CT Colonography
  • Fecal Immunochemical Test (FIT) DNA Lab Test (Cologuard)
  • Flexible Sigmoidoscopy
  • FOBT Lab Test

The U.S. Multi-Society Task Force has classified both the colonoscopy and annual FIT (Cologuard) as tier-1 screening recommendations.

Resources for Patients/Members

On the Provider Resource Center (PRC), practitioners can download the following free educational resources regarding colorectal cancer prevention to share with patients and staff:

To order copies for your practice, go to the PRC > EDUCATION/MANUALS > Inventory Request Form > Select Printable Item. Click the down arrow and then select the items you wish to order. Complete the form and click the ADD TO ORDER button.

Highmark does not recommend particular treatments or health care services. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should determine the appropriate treatment and follow-up with your patient. Coverage of services is subject to the terms of each member’s benefit plan. Additionally, state laws and regulations governing health insurance, health plans and coverage may apply and will vary from state to state.

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.


 

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