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How Does Medicare Cover Colonoscopies?

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By Daniel Petkevich
Dec 27, 2022

Medicare offers coverage for screening colonoscopies once every 2 years

Medicare might not pay for many preventative procedures, but a colonoscopy is an exception. This screening for colon issues is critical to maintaining an awareness of your body. Medicare offers coverage for colonoscopies, but the frequency and cost may change depending on your situation.

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Overview of Medicare Coverage for Colonoscopies

Medicare offers coverage for screening colonoscopies once every 24 months if you’re at high risk for colorectal cancer. If you aren’t at high risk, Medicare will cover the test once every 120 months or 48 months after a prior flexible sigmoidoscopy.

Who is Eligible for a Screening Colonoscopy Under Medicare?

Everyone is eligible for a colonoscopy screening. There are no age requirements. The key is making sure your healthcare provider accepts assignment.

What are the Costs Associated with a Colonoscopy Covered by Medicare?

If your doctor or other qualified healthcare provider accepts assignment, you won’t have to pay anything for the test. However, if your doctor finds and removes a polyp or other tissue during the colonoscopy, you will be required to pay 20% of the Medicare-approved amount for your doctor's services. In a hospital outpatient setting, you will also be responsible for 20% coinsurance.

How to Find Out if Your Doctor Accepts Assignment from Medicare

If you are unsure if your doctor accepts assignment from Medicare, you can contact your doctor’s office to find out. They should be able to provide that information for you.

Tips on Preparing for Your Colonoscopy Appointment

It’s important to prepare properly for your colonoscopy appointment. Here are some tips to help you get ready:
  • Schedule the procedure for a time when it won’t interfere with other activities
  • Read up on the preparation instructions from your doctor or healthcare provider
  • Discuss any medications you take, including vitamins or supplements, with your doctor
  • Follow the dietary instructions provided by your doctor or healthcare provider
  • Ask any questions you have to your healthcare provider prior to the procedure
By understanding the Medicare coverage for colonoscopies and how to prepare for it, you can make sure that you’re adequately prepared. If you still have questions or concerns about Medicare coverage for colonoscopies, you can contact your doctor or healthcare provider. They will be able to provide more information and help guide you through the process.

Conclusion

Medicare offers coverage for screening colonoscopies for those at high risk of colorectal cancer. If you are eligible, Medicare covers the cost of the test itself, with some exceptions depending on what is found during the procedure. Be sure to work closely with your doctor and hospital to understand all the costs associated with the procedure and to make sure that you are fully prepared for your colonoscopy appointment.
For more information about Medicare coverage for colonoscopies, contact your doctor or healthcare provider. They should be able to provide you with detailed information about what is covered and answer any other questions you may have. And for all your Medicare-related questions, call an expert at Fair Square Medicare today.

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