FRM-3006-01-c: Fill out & sign online

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Click ‘Get Form’ to open the FRM-3006-01-c in the editor.
Begin by filling out the Provider Information section. Enter the Healthcare Organization, Location Address, Provider Name, City, State, Zip, Phone Number, and NPI number if available. Ensure all fields marked with an asterisk are completed.
In the Test Information section, specify the Test Name as 'Cologuard' and provide the ICDV10 Code if applicable. Acknowledge your certification as a licensed medical professional by signing in the designated area.
Complete the Patient Assignment of Benefits Notice by having the patient sign and date where indicated. This authorizes billing and disclosure of health records.
Fill out the Patient Information section thoroughly. Include Patient ID/MRN, First Name, Last Name, DOB, Sex, Phone Number (required), Email address (optional), and Language Preference (optional).
Provide Shipping and Billing Address details accurately. If they are the same, indicate this clearly.
Lastly, complete the Patient Insurance/Billing Information section. Attach copies of insurance cards for verification if possible.

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What is the difference between 45380 and 45378?

There are two CPT codes for fecal-occult blood tests: 82270, Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 13 simultaneous determinations, and 82274, Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 13 simultaneous determinations.For most payers

What is CPT code 80081?

A family of CPT codes applies to colonoscopy. For example, code 45378 applies to a colonoscopy in which no polyp is detected, while codes 45380-45385 apply to colonoscopy that involves an intervention (e.g., 45385 is the code for colonoscopy with polypectomy.)

Whats the phone number for Cologuard?

Order a Cologuard Test by Fax Fill out this order form entirely and fax it to Exact Sciences at 1-844-870-8875.

How do I order Cologuard for a patient?

Were here to help. Simply give us a call at 1-844-870-8870.

What is the CPT code for cologuard?

Our 2 Easy Ways to Request Cologuard. If youre 45+ at average risk for colon cancer, there are two easy ways that you can request Cologuard. Simply request it online or talk with your healthcare provider and well deliver your prescribed kit right to your door.