Does Medicare Cover a Colonoscopy?

By Medicare Benefits Solutions - June 5, 2021

Does Medicare cover a colonoscopy? Medicare does offer coverage for colonoscopy screening based on certain risk factors, but Medicare will cover a colonoscopy as long as it has been ordered as a medical necessity by your doctor. Coverage is extended to most Medicare recipients once every 120 months as long as you are not in a high-risk group. If you are at a higher risk for developing colorectal cancer due to family history or other factors, you may receive colonoscopy screening benefits every 24 months.

If you have undergone a flexible sigmoidoscopy, you are able to receive coverage for a colonoscopy screening every 48 months. This is a procedure that examines the sigmoid colon and parts of the large intestine.

Coverage for a colonoscopy is provided under Medicare Part B, the outpatient benefit. In most cases, a colonoscopy is covered at 100%. Most colonoscopy procedures are carried out in a clinical setting, and you are able to leave once the procedure is finished.

If a colonoscopy is required while admitted to a hospital or skilled nursing facility, Medicare Part A may apply instead. Medicare Part A is the inpatient benefit, and it covers services provided by a hospital during the course of admittance.

Although a colonoscopy may not be high on your list of things to look forward to, this procedure plays a vital role in identifying, and by extension, treating diseases like colon cancer early. Early detection is one of the keys to effective treatment of colon cancer, so most adults over the age of 45 are encouraged to work with their healthcare providers to schedule a colonoscopy screening.

If Further Services Are Required

During the course of a colonoscopy, polyps may need to be removed. This is usually taken care of during the colonoscopy to reduce the need for repeat visits. If a polyp is removed or any other medical services are provided during the procedure, Medicare Part B may only cover 80% of the total cost of the additional services.

Coverage for Medications Related to a Colonoscopy

Most colonoscopy procedures will require that your bowels and large intestine be emptied prior to the exam. This is so that no fecal matter or undigested food blocks the scope or obscures the scope’s view. In order to make this process more efficient, most people undergoing a colonoscopy will be instructed to take a laxative prior to the day of the procedure.

If this laxative is ordered by prescription, Medicare Part D may provide coverage. If you purchase a laxative over the counter, you may be responsible for the total cost of the purchase.

Any medications administered during the course of the colonoscopy, including sedatives, will be covered by Medicare as part of the outpatient procedure itself. If medications are required after a colonoscopy to treat any conditions found during the procedure, Medicare Part D would apply toward these drugs as long as they are listed in your plan’s formulary and are purchased from a retail pharmacy for home use.

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