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Colorectal cancer screenings

Medicare covers these screenings to help find precancerous growths or find cancer early, when treatment is most effective. One or more of these tests may be covered:

 

  • Multi-target stool DNA test —This lab test is generally covered once every 3 years if you meet all of these conditions:
    • Are between ages 50–85.
    • Show no symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test.
    • At average risk for developing colorectal cancer, meaning:
      • Have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
      • Have no family history of colorectal cancer or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

You pay nothing for the test if the doctor or other qualified health care provider accepts assignment .

  • Screening fecal occult blood test —This test is covered once every 12 months if you’re 50 or older. You pay nothing for the test if the doctor or other qualified health care provider accepts assignment.
  • Screening flexible sigmoidoscopy —This test is generally covered once every 48 months if you’re 50 or older, or 120 months after a previous screening colonoscopy for those not at high risk. You pay nothing for the test if the doctor or other qualified health care provider accepts assignment .
  • Screening colonoscopy —This test is generally covered once every 120 months (high risk every 24 months) or 48 months after a previous flexible sigmoidoscopy. There’s no minimum age. You pay nothing for the test if the doctor or other qualified health care provider accepts assignment. Note: If a polyp or other tissue is found and removed during the colonoscopy, you may have to pay 20% of the Medicare-approved amount for the doctor’s services and a copayment in a hospital outpatient setting. The Part B deductible doesn’t apply.
  • Screening barium enema —This test is generally covered once every 48 months if you’re 50 or older (high risk every 24 months) when used instead of a sigmoidoscopy or colonoscopy. You pay 20% of the Medicare-approved amount for the doctor services. In a hospital outpatient setting, you also pay the hospital a copayment. The Part B deductible doesn’t apply

 

Source:  Medicare & You 2017

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