Colonoscopies (screening)
Medicare Part B (Medical Insurance) covers screening colonoscopies.
Description
Colonoscopy screening tests check for precancerous polyps (growths in the colon), cancer, and other diseases inside the rectum and colon.
Coverage details
Medicare covers screening colonoscopies and there’s no minimum age requirement to get a screening. If you initially have a Medicare-covered, non-invasive stool-based colorectal cancer screening test (fecal occult blood test or multi-target stool DNA test) or a blood-based biomarker screening test and get a positive result, Medicare also covers a follow-up colonoscopy as a screening test.
Costs
- If your health care provider accepts assignment , you pay nothing for the screening test(s), including follow-up colonoscopies you get after a positive result from a Medicare-covered blood-based biomarker test or non-invasive stool-based test.
- If your health care provider finds and removes a polyp or other tissue during the colonoscopy, you pay 15% of the Medicare-approved amount for your provider's services. In a hospital outpatient setting or ambulatory surgical center, you also pay the facility a 15% coinsurance . The Part B deductible doesn't apply.
How often
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.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
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