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 a minimum age requirement of 45.

Your costs in Original Medicare

If your doctor or other qualified health care provider accepts assignment , you pay nothing for this test. 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, you also pay the hospital a 15% coinsurance . The Part B deductible doesn't apply. 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

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.