MedicaidDocumentationMedium impact
Do's and Don'ts of Colorectal Screening for Clinicians
Aetna Better Health of Virginia·VA · Gastroenterology, Family Medicine, Internal Medicine +1 more·Provider Notification
We identified it
Aug 13, 2026
Summary
This is a clinical guidance policy from Aetna Better Health (Virginia Medicaid) establishing screening recommendations and prohibitions for colorectal cancer screening. Key changes: providers must NOT use digital rectal exams (DREs) for screening, must refer all positive stool tests to colonoscopy, and must not use stool tests for higher-risk patients. Providers should use American Cancer Society (age 45+) or USPSTF (age 50+) guidelines and implement office procedures with EHR prompts and staff coordination.
Action Required
Immediately: Review this policy with all clinical staff, particularly those performing colorectal cancer screening. Billing team should audit recent claims to identify and cancel any pending claims for DRE screening (CPT 99397, 99398, or other annual visit codes billed with DRE modifier/description). Providers must update EHR templates to remove DRE as a screening option and add prompts for colonoscopy referral when stool tests are positive. Front desk and clinical staff should implement patient education and appointment scheduling procedures per office policy. No billing system changes required as this is clinical guidance, not a coverage change. Note: This is a Virginia Medicaid (Aetna Better Health) policy—verify applicability to your specific plans and states.