Does Medicare cover Colonoscopy? – Overview
Screening colonoscopy is crucial to diagnosing colorectal cancer. It provides patients with ample treatment opportunities before the disease progresses further.
According to reports, more than 15 million Americans underwent colonoscopies in the last decade.
Colonoscopies are not cheap and hence not everyone can afford to undergo this test. This is where Medicare insurance plans come as the ideal solution.
Medicare insurance policies provide the expense of screening colonoscopies but at specific time intervals.
These colonoscopies are scheduled based on the patient’s risk for colorectal cancer. Medicare covers the cost of colonoscopy completely.
However, patients may have to pay for the cost of using anesthesia services or removing a polyp.
Let’s take a quick look at how Medicare covers colonoscopy costs. You will also learn how much you may have to pay out of your pocket for the procedure.
Does Medicare Cover Colonoscopy?
Colonoscopy is used by doctors to detect changes or abnormalities in the colon and rectum which may indicate a disease. Even without any symptoms, a person can undergo a screening colonoscopy as a preventive measure.
However, patients with clear symptoms may have to get a screening colonoscopy, which also includes tissue sampling.
The exact type of colonoscopy required will determine the extent of coverage under Medicare insurance.
Colonoscopy Screening with Medicare
Medicare will cover the cost of screening colonoscopy if your doctor agrees to ‘accept assignment’. This means that your doctor agrees to Medicare reimbursement at the standard rate for a screening colonoscopy.
In such cases, Medicare will cover the cost of undergoing screening colonoscopy at these time intervals:
- Every 24 months – This interval is for patients who have a higher-than-average risk of developing colorectal cancer.
- Every 48 months – This interval is for patients who have undergone a flexible sigmoidoscopy.
- Every 120 months – This interval is for people who are not facing an increased risk of colorectal cancer.
If your doctor ‘accepts assignment’ for a straightforward colonoscopy, then Medicare will cover the complete cost of the procedure.
However, if your doctor removes polyps or other tissues for biopsy during the procedure, then this becomes a diagnostic procedure. In such a case, different coverage rules will be applied.
Medicare and Colonoscopy Diagnosis
Colonoscopy diagnosis involves the doctor removing polyps or other tissues for biopsy. Medicare will cover around 20% of the doctor’s services.
It will also cover copayment if the doctor performs the diagnostic procedure at a hospital. Medicare does cover colonoscopy under Part B but its deductibles are not applicable in such cases.
Undergoing a colonoscopy has a significant financial impact on patients. Hence, it is important to know that the cost of treating colorectal cancer is remarkably higher than the cost of preventive screening colonoscopy.
This procedure is crucial for identifying and removing cancerous growth and preventing colorectal cancer.
Make sure to undergo treatment for colonoscopy by a doctor who ‘accepts assignment’ so you can enjoy your Medicare benefits.
Consult with your doctor beforehand whether the procedure would be a simple screening colonoscopy or diagnostic. This way you can ensure that your insurance coverage will absorb the cost of the procedure.