Does Medicare Pay for 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.

  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.