Most HMSA plans include benefits for an annual colorectal screening for members 45 to 75 years of age using FOBT (CPT 82270, 82274, G0328).
If blood occult screening is done because the patient has presented symptoms consistent with a medical condition, benefits are also available to cover FOBT as a diagnostic test. In such a case, the referring physician should provide the laboratory performing the test with an ICD-9-CM/ICD-10-CM diagnosis that accurately reflects the patient’s symptoms.
Claims Filing Information
Billing the correct number of services
All specimens used to complete a single test and payment will be made only for one service. Enter “1” in the days/units column (24G) of the CMS 1500 claim form for the following FOBT codes:
| FOBT Codes | Code Descriptions |
|---|---|
| 82270 |
Blood, occult, by perioxidase activity (e.g., guaiac), feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection) |
| 82274 |
Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations |
| G0328 |
Colorectal cancer screening, fecal occult blood test, immunoassay, 1-3 simultaneous |
Do not bill three separate days for one test.
Diagnosis required
When billing for FOBT done as an annual screening for members age 50 and older, use ICD-9-CM diagnosis code V76.51, special screening for malignant neoplasms, colon/ICD-10-CM diagnosis code Z12.11, encounter for screening for malignant neoplasm of colon
When billing for FOBT that is being performed because the patient has symptoms of a medical condition, use the medical diagnosis code that corresponds to the patient's symptoms.
Return of specimen
Do not bill HMSA for this test if the patient did not return the specimen card for testing.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |