Clinical Lab: NCD 210.3 CRC Biomarker Screening — Update Claims by January 4, 2027
CMS Transmittal R13921CP (CR 14581) updates NCD 210.3 billing for non-invasive colorectal cancer biomarker screening tests, effective January 4, 2027.
Action required by
January 4, 2027
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
CMS Transmittal R13921CP, Change Request (CR) 14581, updates the National Coverage Determination (NCD) 210.3 governing non-invasive biomarker tests used for colorectal cancer (CRC) screening. This is a coverage/billing update published under CMS Publication 100-04 (Medicare Claims Processing Manual), with an implementation date of January 4, 2027. Clinical laboratories, reference labs, and revenue cycle teams processing CRC screening claims under Part B must align their charge capture and claims submission workflows to the revised NCD before that date.
Regulatory Background
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Quick answers
Does CR 14581 affect claims submitted on the 837P (professional) only, or also 837I (institutional outpatient) claims?
NCD 210.3 applies to Medicare Part B coverage of non-invasive CRC biomarker screening tests. Both independent clinical laboratories billing on the 837P and hospital outpatient laboratories billing on the 837I can be subject to NCD coverage edits. CR 14581 updates the MAC shared systems processing logic under Publication 100-04, so both claim types may be affected. Confirm with your MAC whether your specific billing setting is in scope before January 4, 2027.
What is a Dynamic List Data Transmittal, and why does it matter for NCD 210.3 code maintenance?
A Dynamic List Data Transmittal signals that the roster of covered tests or codes under a given NCD is being updated — codes may be added, removed, or have billing instructions revised — without a full manual chapter rewrite. For NCD 210.3, this means the specific HCPCS codes eligible for Medicare coverage as non-invasive CRC biomarker screening tests are changing as of the January 4, 2027 implementation date. Labs must pull the full CR 14581 code list and reconcile it against their CDM and encoder mappings to prevent claim denials.
Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.