Your Medicare Coverage

Is my test, item, or service covered?

Colorectal cancer screenings

How often is it covered?

Medicare Part B (Medical Insurance) covers several types of colorectal cancer screening tests. These tests help find precancerous growths or find cancer early, when treatment is most effective. One or more of these tests may be covered:

When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare covers it:

  • Once every 48 months if you're age 50 or over
  • Once every 24 months if you're at high risk for colorectal cancer

Medicare covers this test once every 24 months if you're at high risk for colorectal cancer.

If you aren't at high risk for colorectal cancer, Medicare covers this test either: 

  • Once every 120 months
  • 48 months after a previous flexible sigmoidoscopy

Medicare covers this lab test once every 12 months if you're age 50 or older.

Medicare covers this at-home test once every 3 years for people who meet all of these conditions:

  • They're between 50–85
  • They show no signs or symptoms of colorectal disease including, but not limited to:
    • Lower gastrointestinal pain
    • Blood in stool
    • Positive guaiac fecal occult blood test
    • Fecal immunochemical test
  • They're at average risk for developing colorectal cancer, meaning:
    • They have no personal history of these:
      • Adenomatous polyps
      • Colorectal cancer
      • Inflammatory bowel disease, including Crohn's Disease and ulcerative colitis
    • They have no family history of these:
      • Colorectal cancers or adenomatous polyps
      • Familial adenomatous polyposis
      • Hereditary nonpolyposis colorectal cancer

Medicare covers this test once every 48 months for most people age 50 or older. If you aren't at high risk, Medicare covers this test 120 months after a previous screening colonoscopy.

Who's eligible?

All people age 50 or older with Part B are covered. People of any age are eligible for a colonoscopy.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount for your doctor's services. In a hospital outpatient setting, you also pay a copayment.

You pay nothing for the screening colonoscopy, if your doctor or other qualified health care provider accepts assignment.

A screening colonoscopy can become a diagnostic colonoscopy when:

  • The screening colonoscopy results in the biopsy or removal of a lesion or growth
  • The biopsy or removal happens during the same visit as the screening colonoscopy

When the colonoscopy procedure is considered diagnostic:

  • You may pay 20% of the Medicare-approved amount for your doctor's services
  • You may pay a copayment in a hospital setting
  • The Part B deductible doesn't apply

You pay nothing for the screening fecal occult blood test. This screening test is covered if you get a referral from one of these:

  • Your doctor
  • Your physician assistant
  • Your nurse practitioner
  • Your clinical nurse specialist

You pay nothing for a multi-target stool DNA test

You pay nothing for the screening flexible sigmoidoscopy, if your doctor or other qualified health care provider accepts assignment.

A screening flexible sigmoidoscopy can become a diagnostic flexible sigmoidoscopy when:

  • The screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or growth
  • The biopsy or removal happens during the same visit as the screening flexible sigmoidoscopy

When the flexible sigmoidoscopy procedure is considered diagnostic:

  • You may pay 20% of the Medicare-approved amount for your doctor's services
  • You may pay a copayment in a hospital setting
  • 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
  • Whether 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 whether Medicare will pay for them.

Related resources

Return to search results