Does Medicare Cover Colonoscopy?

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Does Medicare Cover Colonoscopy?

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A colonoscopy is one of the most common cancer screening tests and is extremely helpful in the early detection of colorectal cancer. The question you’re probably asking is, “Does Medicare cover colonoscopy?” What is covered under Medicare and what will they pay? Let’s find out.

In this article we’ll discuss:

Does Medicare Cover Colonoscopy?

Yes, Medicare will cover all of your colorectal screenings. This includes your anesthesia that is required to complete the procedure. Your Medicare Part B deductible will not apply to your colonoscopy. Medicare pays its share no matter if you have (or haven’t) met your deductible for the entire year. 

does medicare pay for colonoscopy

Does Medicare pay for Colonoscopy?

Yes! Original Medicare will for your colonoscopy screening test. You will not have to pay anything as long as your screening is completed by a qualified health care provider or doctor that accepts Medicare assignment.

You may have to pay 20%

If your doctor or provider finds a polyp or tissue that is removed during your colonoscopy, you may be responsible for the 20% of the Medicare-approved amount of your physician's services and copay in a hospital setting. Your Medicare Part B deductible will not apply.

how often will medicare pay for a colonoscopy?

You will be able to schedule your Medicare colonoscopy screening based on these details:

  • 1 screening every 24 months for “High Risk” for colorectal cancer
  • 1 screening every 120 months for anyone that is “Not High Risk” 
  • 48 months after a flexible sigmoidoscopy has been performed

how much does a colonoscopy cost?

The average colonoscopy costs approximately $3,081. These costs can range from around $2,000 to almost $4,000. 

Your doctor’s charge isn’t the only medical bill for a colonoscopy procedure. There are many other charges that can be associated with the total cost of your colonoscopy which can include:

  • Colonoscopy prep kits: Hospitals often provide these while some providers offer. Some will instruct their patients which ones to buy.
  • Anesthesia: Will you be sedated? Will an anesthesiologist administer your sedation? This will affect the total cost.
  • Facility charges: Your hospital, physician’s office, or surgery center may charge an additional fee for using their space.
  • Fees for diagnosis: Fees can differ and will depend on whether your colonoscopy is being done for diagnosis of symptoms, cancer screening,  colonoscopy with removal of a tissue or polyp, colonoscopy with a biopsy.
  • Pathology: The examination of tissues that were removed during the colonoscopy.

how much does medicare pay for colonoscopy?

The cost of your colonoscopy with Medicare is going to depend on if your colonoscopy is for preventative screening or diagnostic purposes. It’s also dependent upon if your provider or doctor accepts assignment with Medicare.

how much does a colonoscopy cost with medicare?

Preventative Colonoscopy

$ 0
00 Total Cost
  • Medicare Part A or Medicare Part B will pay for your colonoscopy screening in full if your colorectal procedure is preventive.

Diagnostic Colonoscopy

20%
Total Cost
  • Your screening will become a diagnostic service if tissues or polyps are identified & removed.
  • Medicare will pay 80% of the allowable costs, leaving you responsible for the remaining 20%

How will your Medicare Supplement plan pay for your colonoscopy isn’t always clear. There are several factors that come into play when calculating the cost of these services.

Make sure you reach out to your insurance company directly and communicate with your doctor to find out an estimate. When your provider or doctor recommends a colonoscopy that goes over the amount that Medicare covers, you may want help covering the balance.

If your physician or provider recommends that you have a colonoscopy more than Medicare typically covers, you may be responsible to pay all  or some of the cost.

Before your undergo the actual colonoscopy, ask your physician about the costs involved and why your doctor recommends need the screening.

medicare coverage for colonoscopy FAQ

YES.

Although the US Preventive Services Task Force recommends screenings from ages 50 to 75, Medicare will pay or reimburses colonoscopies. In other words, Medicare will continue to pay for colorectal screenings for people ages 75 and older.

YES.

Medicare will cover your colon polyp removal. However, the level of coverage will vary.

High risk patients will be covered for 1 colonoscopy every 2 years. Medicare covers and pays for this screening.

Colonoscopy prep kits are not covered under Medicare Part B. When your physician or provider prescribes you a colonoscopy prep kit, you will have to get it filled at your pharmacy and they will bill it under your Part D drug plan. 

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