PROVIDER INFORMATION ORDER INFORMATION PATIENT AUTHORIZATIONS ASSIGNMENT OF BENEFITS AOB FINANCIAL RESPONSIBILITIES PATIENT ETHNICITY AND RACE The completion of this section is optional. Contact us to discuss and get started with electronic options.
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Talk to your healthcare provider If youre 45 or older ask your healthcare provider about screening for colon cancer with Cologuard.
How to order cologuard. If youd rather not make an appointment with your regular doctor simply to discuss Cologuard the doctors at PlushCare can write you a prescription after a 15 minute virtual or telephone appointment. Or have a family history of colorectal cancer or certain hereditary syndromes. EXACT SCIENCES LABORATORIES LLC.
Download an Order Form PDF. Stool-based DNA test with hemoglobin immunoassay component. Cologuard Exact Sciences Laboratories NPI 145 E Badger Rd Madison WI.
We can send your kit via UPS to your PO box if that is where you normally receive packages. The Cologuard testing kit will contain a sample container a tube preserving liquid labels and instructions on how to collect the sample. How do I order Cologuard.
COLOGUARD ORDER REQUISITION FORM. Once a stool sample is taken the package will be picked up and returned to the Cologuard lab. 145 E Badger Rd Ste 100 Madison WI 53713.
You can fill out a form on the companys website that generates a. All instructions and a pre-paid shipping label will be included in the package. Do not use if you have had adenomas have inflammatory bowel disease and certain hereditary syndromes or a personal or family history of colorectal cancer.
Cologuard has a 12 false positive rate and that rate increases as people age. Order Cologuard by Fax. By steven vig md.
Download an order form and fax it to 1-844-870-8875. To begin the blank utilize the Fill Sign Online button or tick the preview image of the document. Most simple way to begin ordering.
Cologuard is only billed under CPT code 81528. You need to make an appointment with your doctor to request Cologuard. Your doctor will need to prescribe the test for you before youre able to order a Cologuard kit.
Can Cologuard be mailed to a PO box. Requires IT department EMR vendor or lab partner. Cologuard is intended to screen adults 45 years of age and older who are at average risk for colorectal cancer by detecting certain DNA markers and blood in the stool.
This code was established by the American Medical Association CPT Editorial Panel and recognized by Medicare with an effective date of 112016. How you can complete the Cologuard order form on the web. Cologuard is not for high-risk individuals including patients with a personal history of colorectal cancer and adenomas.
Request Cologuard online If youve discussed Cologuard with your healthcare provider in the past and believe it may have been ordered for you please call Exact Sciences Laboratories at 1-844-870-8870. You can order Cologuard using the following link below. It will be sent by mail to your address.
You collect the sample at home and send it back to the lab for testing. How to order cologuard in athena a screening test for colon neoplasia. Cologuard is less accurate than a colonoscopy at detecting polyps of any size.
The advanced tools of the editor will lead you through the editable PDF template. I authorize Exact Sciences Laboratories Exact to bill my insurancehealth plan and furnish them with my Cologuard order information test results or other. When returning your kit you will need to contact UPS to schedule a pickup or drop off your kit at a UPS location.
Enter your official identification and contact details. Think you might want a Cologuard prescription. Have been diagnosed with a condition associated with high risk for colorectal cancer such as IBD chronic ulcerative colitis Crohns disease.
Cologuard is better at detecting cancer than FIT 92 vs 70 for FIT but the false positive rate is higher. Get started with a secure fax line. The Cologuard testing kit for colon and rectal cancer must ordered by your health care provider.
Once ordered you will receive a kit via UPS or Fedex within 1 week. Cologuard can detect 92 of cancers but only 42 of large precancerous polyps. Click the button below to download an order form.
Have had a positive result from another colorectal cancer screening method within the last 6 months. It is also known as a HCPCS Level I or CPT Category I code.
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