Medicare Coverage of Colonoscopy

What It Is

Colonoscopy cancer screening test

What's Covered

Medicare Part B covers an outpatient colonoscopy. How often Medicare Part B covers the procedure depends on the patient's medical history:

  • For people who are not considered at high risk for colorectal cancer, one test every ten years (but not within four years after a flexible sigmoidoscopy.

  • For people who are at high risk for colorectal cancer, based on their personal and family medical history, one test every two years.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for a colonoscopy, contact the plan directly.

What Medicare Pays

Medicare Part B pays 80 percent of the Medicare-approved amount for the procedure if performed at a doctor's office, clinic, or health center. If the procedure is performed in a hospital outpatient department or ambulatory surgical center, Medicare Part B pays 75 percent of the Medicare-approved amount.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

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17 Comments So Far. Add Your Wisdom.

Anonymous said 6 months ago

The nursing told us on intake, we'll have to wait until mother is released from skilled nursing for medicare to cover a colonoscopy. Their means of handling her discomfort has been 4 months of daily laxatives. This is horrible.

10 months ago

doe medicare pay for colonoscopy when you are 85 yrs old?

10 months ago

I had a colonoscopy over 4 years ago. At the time doctor said we'll do another in 3 years. I am 76 years old and have Medicare A and B and a secondary with United Health Care. Am I too old now? I have had several over the years.

11 months ago

The dr ordered a colonostpy to diagnosis chronic diahhrea will Medicare cover I am 79 and had one 9 yrs ago

over 1 year ago

my family is high risk colon cancer; several on mother's side had it and had surgery for it; I have multiple adematous polyps which cause colon cancer, and I am fearful that I will not be able to get it after age 75. I'm due this year, and in 3 years (my regimen because of my high risk) I will be 75. I am fearful of having colon cancer and dying a painful death because of the medicare/obamacare. I know the current government wants old people to die off. I also have longevity in my family, several have lived (including the colon cancer family) over 100 years of age.

over 1 year ago

correction to my prior question - I meant to ask "do I have to wait another 5 years for colonoscopy" not 10 years as I wrote.

over 1 year ago

Question...What considerations come into play in determining whether one is a "high risk for colorectal cancer" patient? I understand if there is a family history component but if this is not a factor who/when/why determines "high risk"? I have had an atypical (for me) string of constipation bouts lately. A possible cause for this could be colon cancer. I had a colonoscopy 5 years ago that was determined to be normal (no polyps or other suspicious symptoms). In that Medicare only pays for the test every 10 years for non-high risk patients, do I have to wait another 10 years even though I may have symptoms that may (or may not) be significant?

over 1 year ago

I am having an ordered colonoscopy Thursday, July 11, for weight loss. There is cancer history in my family. My grandfather died from colon cancer. Will Medicare pay for 80% of the charges and my military insurance, TRICARE FOR LIFE, the other 20%? Or, will Medicare only pay 80% of the U&C and will TRICARE pay the 20% of what Medicare approves?

over 1 year ago

If I have Medicare part A and B, will it cost me more to have a colonoscopy in my doctor's office or in the hospital. What about the total costs in those 2 locations....which is more expensive.

almost 2 years ago

It would also be helpful for this page to note what the cost to the patient would be from any lab required should a polyp be found and excised.

almost 2 years ago

I'm 70 and both of my parents had colon cancer. My primary ordered the colonoscopy having had one eleven years earlier. All the Medicare rules were followed including having the procedure in the physician's clinic. I got a $750 bill from the doctor which I paid my $50 co-pay but then I got another $700 bill from the affiliated hospital and $600 for the anesthetic with no indication of the co-pay or Medicare payments that apply. What do I do? If Medicare pays 80% or 75% why am I charged nearly 70% of the total?

over 2 years ago

I am 66 and have not had a colonoscopy yet. Can anyone tell me what the 20% of medicare part B cost is more or less? I do not know what the average cost of colonoscopy is. Thank you.

over 2 years ago

Just for the record (re: Stickittome's comment), being awake for a sigmoidoscopy is usually no big deal, and if the provider has an available "t.v. monitor," you may be able to view your own lovely pink colon from the inside and to converse with the physician about what may be discovered during the procedure in real time.

over 2 years ago

Will Medicare pay if you had vone done 6 years ago with private insurance?

over 2 years ago

Information was helpful, but not not enough information. Like will Medicare pay for you to be put to sleep, for this proceedure. I was told that they may or may not pay. Just try having a Flexible Sigmoidoscopy Examination without being put to sleep.

over 4 years ago

god be with you & your family whenever you have this test done !!!

almost 5 years ago

I have had a colonscopy test done i have it in 3 years.


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