COL: Colorectal Cancer Screening
Screening within recommended intervals: annual FIT/gFOBT, FIT-DNA every 3 years, sigmoidoscopy every 5 years, colonoscopy every 10 years, CT colonography every 5 years.
Measure description
Screening within recommended intervals: annual FIT/gFOBT, FIT-DNA every 3 years, sigmoidoscopy every 5 years, colonoscopy every 10 years, CT colonography every 5 years.
Eligible population
Adults 45-75
Performance drivers
Recently expanded to age 45+ per USPSTF 2021 update.
Documentation & PA strategy
Screening typically not requiring PA. Diagnostic colonoscopy after positive FIT/Cologuard may have PA. Use ICD-10 Z12.11 for screening.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure COL measure?
Screening within recommended intervals: annual FIT/gFOBT, FIT-DNA every 3 years, sigmoidoscopy every 5 years, colonoscopy every 10 years, CT colonography every 5 years.
What drives performance on this measure?
Recently expanded to age 45+ per USPSTF 2021 update.
How should clinicians document for this measure?
Screening typically not requiring PA. Diagnostic colonoscopy after positive FIT/Cologuard may have PA. Use ICD-10 Z12.11 for screening.
What is the eligible population?
Adults 45-75
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