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The Centers for Medicare and Medicaid Services and others misunderstand stool testing for colorectal cancer
Journal article   Peer reviewed

The Centers for Medicare and Medicaid Services and others misunderstand stool testing for colorectal cancer

Gloria D Coronado, Richard M Hoffman, Josheili Llavona-Ortiz and Carolyn M Rutter
JNCI : Journal of the National Cancer Institute, Vol.118(3), pp.386-391
03/2026
DOI: 10.1093/jnci/djaf341
PMCID: PMC13017659
PMID: 41324575

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Abstract

The May 2021 Centers for Medicare and Medicaid Services (CMS) coverage determination allowed reimbursement for blood-based biomarker tests and other tests for colorectal cancer (CRC) screening that meet minimum 74% sensitivity and 90% specificity thresholds. However, these performance benchmarks fail to account for the importance of detecting precancerous lesions and the impact of the recommended testing interval on the effectiveness of screening. We review the limitations of the CMS criteria, summarize supporting evidence for stool-based testing and colonoscopy as effective and cost-efficient screening modalities, and offer recommendations to strengthen CMS coverage decisions to better align with public health goals in CRC prevention.

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