Medicare.gov

Colonoscopies

Medicare covers screening colonoscopies once every 24 months if you’re at high risk for colorectal cancer. If you aren’t at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy. There’s no minimum age requirement.

If you initially have a non-invasive stool-based screening test (fecal occult blood tests or multi-target stool DNA test) and receive a positive result, Medicare also covers a follow-up colonoscopy as a screening test.

Your costs in Original Medicare

If your doctor or other health care provider accepts assignment , you pay nothing for the screening test(s). However, if your doctor finds and removes a polyp or other tissue during the colonoscopy, you pay 15% of the  Medicare-Approved Amount  for your doctors' services. In a hospital outpatient setting or ambulatory surgical center, you also pay the facility a 15% coinsurance  amount. The Part B deductible doesn't apply. 

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • If your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

 

What it is

Tests to help find precancerous growths or find cancer early, when treatment is most effective.

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