How often is it covered?
- Fecal Occult Blood Test: Once every 12 months.
- Flexible Sigmoidoscopy: Generally, once every 48 months, or 120 months after a previous screening colonoscopy for people not at high risk.
- Screening Colonoscopy: Generally once every 120 months (once every 24 months if you're at high risk), or 48 months after a previous flexible sigmoidoscopy.
- Barium Enema: Your doctor can decide to use this test instead of a flexible sigmoidoscopy or colonoscopy. This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren't at high risk.
You're at high risk if you have any of the following risk factors:
- A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp (a type of polyp that could become cancerous)
- A family history of familial adenomatous polyposis (this involves multiple adenomatous polyps, often in the hundreds, and carries a very high risk of colon cancer)
- A family history of hereditary nonpolyposis colorectal cancer (a type of colorectal cancer that runs in families and tends to cause cancer at a relatively young age - under 45 years)
- A personal history of adenomatous polyps
- A personal history of colorectal cancer
- A personal history of inflammatory bowel disease, including Crohn's Disease and ulcerative colitis
Who’s eligible?
All people with Medicare are eligible for a screening colonoscopy. All other colorectal screenings are available to people with Medicare age 50 and older.
Your costs in Original Medicare
- Colonoscopy—This test is generally covered once every 120 months (high risk every 24 months) or 48 months after a previous flexible sigmoidoscopy. No minimum age. You pay nothing for this test if the doctor or other health care provider accepts assignment. Note: If a polyp or other tissue is found and removed during the colonoscopy, you may have to pay 20% of the Medicare-approved amount for the doctor's services and a copayment in a hospital outpatient setting.
- You pay nothing for the fecal occult blood test. You pay nothing for the flexible sigmoidoscopy or screening colonoscopy, if your doctor accepts assignment.
- For barium enemas, you pay 20% of the Medicare-approved amount for the doctor's services. The Part B deductible doesn't apply. If it's done in a hospital outpatient setting, you pay a copayment.
Colorectal Cancer Resources