Does Medicare Cover Colonoscopies?
If you are at high risk for colorectal cancer, Original Medicare will cover a screening colonoscopy every 24 months. If you’re not at high risk, Medicare covers this preventive screening every 120 months or 48 months after a previous flexible sigmoidoscopy.
There is no age restriction for beneficiaries getting a screening test. If your initial non-invasive screening test shows positive results for fecal occult blood or multi-target stool DNA, Medicare will cover the cost of a screening colonoscopy as a follow-up.
It is important to note that Medicare only covers the cost of colonoscopy screening. Any additional procedures, such as biopsy or polyp removal, will incur additional charges. However, if your doctor determines that the removal is medically necessary during the process, Medicare will cover the cost.
What Is Considered High Risk?
Individuals who are considered to be at high risk include any of the following:
• Family history of colorectal cancer
• Personal history of adenomatous polyps or colorectal cancers
• Personal history of inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease
• Certain inherited syndromes that increase the risk of colorectal cancer
Do I Have to Pay Anything for a Colonoscopy That Medicare Covers?
If your healthcare provider accepts Medicare’s payment, you can get a colorectal cancer screening under Medicare Part B without paying any deductible, coinsurance, or copayment. This applies even if you still need to reach your annual deductible.
You may be charged if your doctor removes a polyp or other tissue during the diagnostic colonoscopy. However, you won’t need to pay the 2024 Part B deductible of $240.
Medicare Part B will cover the cost of a colonoscopy every 24 months for high-risk patients. Your Medicare coverage will also pay for the procedure once every 120 or 48 months for those who do not have any risk factors. It is important to remember that if additional procedures are done during the colonoscopy, such as biopsy or polyp removal, you may be responsible for additional costs. Medicare Part B will cover the cost of a diagnostic colonoscopy even if you haven’t met your deductible for the year. Please be sure to check with your doctor and healthcare provider to make sure they accept assignments so you don’t have to pay out-of-pocket costs.
Does Medicare pay for colonoscopy anesthesia?
Yes. Medicare Part B covers the total cost of anesthesia used during a colonoscopy to screen for or diagnose colon cancer.
Is there a maximum age that Medicare covers colonoscopies?
No. Medicare covers colonoscopies for individuals of any age, with no age limitations. However, the frequency of coverage depends on the reason for the procedure.