Medicare Colonoscopy Coverage: What You Need to Know

Medicare offers coverage for preventive screenings like a colonoscopy, which checks for problems such as pre-cancerous polyps. With early detection, the polyps can be removed before they become cancerous. An individual on Medicare should understand the coverage available to have a colonoscopy.

Purpose

• An individual age 50 or older with an average risk for colon cancer should have a colonoscopy done once every 10 years. A patient also may have a colonoscopy when he has abdominal pain, constant constipation or diarrhea, or other intestinal problems.

Coverage

• A patient is eligible for a colonoscopy based on his risk level for having colon cancer. A patient considered high-risk could have a colonoscopy once every two years.

Cost

• A patient will pay his co-insurance or co-payment for the procedure. If he has Medicare Part B, there is no deductible when the colonoscopy does not result in a biopsy or the removal of a lesion. A colonoscopy done at a hospital as an outpatient procedure or at an ambulatory surgical center requires the patient to pay 25 percent of the cost.

Additional Screenings

• Medicare covers other colon cancer screenings like fecal occult blood test, flexible sigmoidoscopy and barium enema.