Does Medicare Cover Colonoscopy Screenings?

Medicare Part B covers colonoscopy screenings every 24 months if you have a high risk for colorectal cancer.

If you don’t have a high risk for colorectal cancer, Medicare Part B will cover a colonoscopy once every ten years, or 48 months following a flexible sigmoidoscopy.

Medicare Part B may also help cover other types of colorectal cancer screenings.

Man talks with his doctor

Medicare Part B covers colorectal cancer screenings

Colonoscopies and other colorectal screenings can be helpful in detecting precancerous polyps or colorectal cancer at an early stage. These fall under Medicare’s definition of preventive and screening services.

As long as your doctor accepts Medicare assignment — meaning they accept Medicare’s reimbursement for your procedure as payment in full — a colonoscopy and certain other colorectal screenings are covered 100 percent by Medicare Part B.

In addition to colonoscopies, Medicare Part B may the following colorectal screenings at no cost to you if you meet the required guidelines:1

  • Screening fecal occult blood test
    Medicare covers this screening once every 12 months at no cost if you receive a referral from a doctor, physician’s assistant, nurse practitioner or clinical nurse specialist.

  • Multi-target stool DNA test (Cologuard)
    Medicare covers this test at no cost once every three years if you are at average risk of colorectal cancer, show no signs of symptoms of colorectal disease and are between the ages of 50-85.

  • Screening flexible sigmoidoscopy
    This screening is covered by Medicare at no cost (typically once every 48 months) if you are 50 or older and your doctor accepts Medicare assignment. If you aren’t at high risk for colorectal cancer, it is covered every ten years following a screening colonoscopy.

Medicare Part B will also help pay a portion of another screening test, called a screening barium enema. However, you are typically responsible for 20 percent of the Medicare approved amount. You’ll also pay a copayment if it is performed in a hospital outpatient setting.

If you are 50 or older, a screening barium enema is covered every 48 months, or every 24 months if you have a high colorectal cancer risk.

Colorectal screening procedures vs. colorectal diagnostic procedures

It’s important to note that a screening colonoscopy or flexible sigmoidoscopy can become a diagnostic procedure if a growth is found and it is biopsied or removed.

If your screening becomes diagnostic in nature, you can expect to pay 20 percent of the Medicare-approved amount of the procedure, plus a copayment if it is performed in a hospital outpatient setting.

Medicare Advantage plans cover colonoscopy screenings

Are you ready to learn more about Medicare benefits and Medicare enrollment? Did you know that Medicare Advantage plans (Medicare Part C) cover the same benefits as Original Medicare (Medicare Part A and Part B)? Did you know that some Medicare Advantage plans even offer additional benefits that Original Medicare doesn’t cover?

Give a licensed insurance agent a call today. They can help explain the preventive services like colonoscopy screenings and other benefits that may be covered by Medicare Advantage plans in your area.

Call TTY Users: 711 (24 hours a day, 7 days a week) to get started.

 

Learn more about what Medicare covers

 

1 Medicare.gov. Colorectal Cancer Screenings. Retrieved from www.medicare.gov/coverage/colorectal-cancer-screenings.

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