Does Medicare Cover a Colonoscopy?
Does Medicare cover colonoscopy costs? Here's everything you need to know about paying for your exam.
Yes, Medicare covers colonoscopy screenings. Medicare coverage is designed to offer preventive care, such as screenings that detect diseases at their earliest stages. This is why Medicare offers colonoscopy screenings and other services that help detect potential health issues early.
Learn more about how much Medicare does pay for colonoscopy screenings.
Types of Colonoscopy Screenings Medicare Does Pay For
If you're over 50 and have Medicare Part B, your Medicare colonoscopy coverage includes colorectal cancer screenings, which detect precancerous growths or find cancer early:
Screening barium enema
If this test is used in place of a flexible sigmoidoscopy or colonoscopy, Medicare covers this screening every 48 months if you are 50 or older. Medicare covers you every 24 months if you're at high risk for colorectal cancer.
Medicare covers this exam every 120 months if you aren't at high risk, or every 48 months following a flexible sigmoidoscopy. Again, this exam is covered every 24 months if you're someone who carries a high risk for colorectal cancer.
Screening fecal occult blood test
This lab test is covered every 12 months if you are 50 or older.
Multi-target stool DNA test
Medicare covers this test, which can be administered at home, every three years for those who meet the following conditions:
- You're between the ages of 50-85
- You show no symptoms of colorectal disease, such as lower gastrointestinal pain, or a positive result of a guaiac fecal occult blood test
- You're at average risk for developing colorectal cancer, meaning you have no history of adenomatous polyps, colorectal cancer, Crohn's Disease, or ulcerative colitis
- You have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or colorectal cancer that exhibits hereditary nonpolyposis
Screening flexible sigmoidoscopy
This exam is covered under Medicare every 48 months for people 50 and older, though if you're not high risk, it's covered 120 months after your previous colonoscopy.
How Much Does Medicare Pay for Colonoscopy Screenings?
Does Medicare cover colonoscopy screenings? If you have Medicare, the following list provides some insight into some of the costs associated with a colonoscopy screening.
- If you receive a barium enema, you'll have to pay 20 percent of Medicare's approved cost for your doctor's services
- Multi-target stool DNA tests won't cost you anything
- If you get a colonoscopy or flexible sigmoidoscopy that leads to a biopsy or the removal of a lesion or growth (in that visit to the physician), Medicare considers the procedure to be diagnostic. In this case, you may have to pay coinsurance
- Fecal occult blood tests are entirely covered, so you don't pay anything, provided you get a referral from a health care provider
- You don't pay anything for colonoscopies or flexible sigmoidoscopies, provided your doctor accepts Medicare assignment.
It is also important to remember that Original Medicare requires you to pay several out-of-pocket costs, including a deductibles, coinsurance and copayments.
Learn more about Medicare coverage of common procedures.
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