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News
Medicare just gave nurse practitioners, physician associates, and advanced practice nurses the green light to independently order noninvasive colorectal cancer screenings — no physician sign-off required. The updated National Coverage Determination removes a longstanding administrative hurdle, covering RNA-based, DNA-based, and fecal occult blood tests. The change is especially significant for patients in rural and underserved areas, where APPs are often the primary — or only — healthcare provider.
Medicare has updated its National Coverage Determination (NCD) to allow nurse practitioners (NPs), physician associates (PAs), and advanced practice registered nurses (APRNs) to independently order noninvasive colorectal cancer screening tests for Medicare patients — without requiring a physician's order. Previously, NPs could only independently order fecal occult blood tests (FOBT), while most other screenings required physician authorization, forcing patients into extra visits and creating unnecessary delays in care.
The finalized rule, effective June 2026, now covers RNA-based stool tests, DNA-based stool tests, DNA-based blood tests, and FOBT when ordered by APPs. The AAPA played a key role in shaping the final policy, successfully advocating for the inclusion of FOBT — which was initially left out of the proposed rule — alongside advanced molecular tests.
Key Takeaways:
Why it matters: This policy shift reduces administrative friction for millions of Medicare patients — particularly those in rural and underserved areas — who rely on APPs as their primary care providers. By streamlining access to early detection tools, the change could meaningfully improve colorectal cancer outcomes at a population level.
