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Does Medicare Cover a Colonoscopy?

En español | If you have Medicare, you should not have to pay for a preventive colonoscopy. How often you can have the procedure covered depends on your health circumstances.

If you are at high risk for colorectal cancer, Medicare will cover the full cost of a colonoscopy once every two years. If you are not at high risk, it will pay for the screening once every 10 years, or four years after you have undergone a flexible sigmoidoscopy, a similar procedure that does not probe the entire colon.

Original Medicare pays the full cost of a colonoscopy if a medical provider who accepts Medicare rates does the procedure.

However, if a polyp is found and removed during the colonoscopy, the procedure is considered diagnostic rather than preventive and you likely will owe 20 percent of the Medicare-approved fee. Medicare Advantage plans cover the test under similar terms if a doctor in the plan’s network handles it.     

The Medicare Part B deductible does not apply to colonoscopies. Medicare will pay its share whether or not you’ve met your deductible for the year.

If your doctor recommends you have a colonoscopy more often than Medicare normally covers, you may have to pay some or all of the cost. Ask your doctor why he or she is recommending the test and whether Medicare will pay for it.

Colorectal cancer: risk factors

Medicare pays for more frequent colonoscopies for people at high risk of developing colorectal cancer.

According to the Centers for Medicare & Medicaid Services, that means someone meets one or more of these criteria.

  • Has a personal history of colorectal cancer; adenomatous polyps, a form of polyp that is benign but can become cancerous; or an inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.
  • Has a close relative — a parent, sibling or child — who has had colorectal cancer or an adenomatous polyp.
  • Has a family history of inherited syndromes linked to colorectal cancer, such as familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome.

Editor's note: This article was originally published on July 17, 2015. It has been updated with the latest information regarding Medicare coverage in 2020.


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