Does Medicare cover colonoscopies?

What does Medicare cover for colonoscopies?

Medicare Part B covers screening colonoscopies, which check for precancerous polyps (growths in the colon), cancer and other diseases inside the rectum and colon. There's no minimum age requirement to get a screening colonoscopy.

Part B also covers a follow-up colonoscopy as a screening test if you first have a Medicare-covered, non-invasive stool-based screening test (a fecal occult blood test or a multi-target stool DNA test) or a blood-based biomarker screening test and get a positive result. See Medicare coverage of stool DNA tests.

How often does Medicare pay for a screening colonoscopy?

How often Medicare Part B covers a screening colonoscopy depends on your risk for colorectal cancer:

• If you're at high risk for colorectal cancer: once every 24 months.
• If you aren't at high risk: once every 120 months, or 48 months after a previous flexible sigmoidoscopy.

What do I pay for a colonoscopy with Medicare?

You pay nothing for the screening colonoscopy if your doctor or other health care provider accepts assignment, including a follow-up colonoscopy you get after a positive result from a Medicare-covered blood-based biomarker test or non-invasive stool-based test.

If your 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 an ambulatory surgical center, you also pay the facility a 15% coinsurance. The Part B deductible doesn't apply.

Assignment means your provider agrees to accept the amount Medicare approves as full payment. A provider that doesn't accept assignment can charge you more than the Medicare-approved amount, and you might have to pay the full amount at the time of service, so check before your appointment.

What other colorectal cancer screenings does Medicare cover?

Medicare Part B covers several other colorectal cancer screening tests, and you pay nothing for each of them if your provider accepts assignment:

• Fecal occult blood test: once every 12 months if you're 45 or older, with a referral from your doctor, physician assistant, nurse practitioner or clinical nurse specialist.
• Multi-target stool DNA test: every 3 years if you're 45 to 85, have no symptoms of colorectal disease and are at average risk for colorectal cancer.
• Blood-based biomarker test: once every 3 years (if available) if you're 45 to 85, have no symptoms of colorectal disease and are at average risk.
• Flexible sigmoidoscopy: for most people 45 or older, 48 months after a previous flexible sigmoidoscopy or CT colonography, or, if you aren't at high risk, 120 months after a previous screening colonoscopy. If a lesion or growth is removed, you pay 15% of the Medicare-approved amount for your doctor's services, plus a 15% facility coinsurance in a hospital outpatient setting or ambulatory surgical center.
• CT colonography (a virtual colonoscopy): if you're 45 or older and your doctor, physician assistant, nurse practitioner or clinical nurse specialist orders it, once every 24 months if you're at high risk, or once every 60 months (or 48 months after a previous flexible sigmoidoscopy or colonoscopy) if you aren't.

Does Medicare Advantage or Medigap change what I pay?

Medicare Advantage plans must give you at least the same coverage as Original Medicare, but a plan may have different rules, like using doctors in the plan's network, and costs vary by plan.

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private insurance company to help pay your share of costs in Original Medicare, like coinsurance and deductibles. You can only buy Medigap if you have Original Medicare.