A colonoscopy is a medical procedure that doctors use for diagnostic screening for colorectal cancer, the third most common form of cancer in the United States. Its purpose is to find pre-cancerous polyps in the colon so they can be removed at an early stage, when treatment is the most effective.

Most medical professionals recommend that people have a colonoscopy every 10 years beginning at the age of 50 for individuals who are not at high risk.

If you are at a higher risk, your physician may suggest having a colonoscopy more often than every 10 years. The risk for colorectal cancer increases if you have a family or personal history of colorectal cancer or pre-cancerous polyps, inflammatory bowel disease, or other hereditary factors.

After the age of 50, the risk for colorectal cancers increases and for those who are between 76 and 85, physicians may suggest more frequent colonoscopy screenings.

Differences Between a Virtual and Standard Colonoscopy

A standard colonoscopy takes between 30 to 60 minutes. The patient is under sedation and lies on an exam table while the physician inserts a long, flexible instrument into the colon. This transmits images of the colon lining. During the exam, if the doctor discovers abnormal growths or polyps, he removes them, and they are sent for a biopsy.

To prepare for a standard colonoscopy, you consume a prescribed solution the night before to clean out your bowels. After the exam, you spend a short time in recovery for observation before leaving with someone who can drive you home.

For a virtual colonoscopy, the doctor uses a CT scan together with computer software to create images of the colon. It is performed in a hospital or clinic that has an imaging department.

As for a standard colonoscopy, you lie on your side while a flexible tube is inserted into the colon. No sedation is required for this procedure. The day before the procedure, you may take some medication to clear the colon.

In contrast with a standard colonoscopy, during a virtual colonoscopy if the doctor discovers polyps or abnormal tissue, they cannot be removed, and you must then have a standard colonoscopy for their removal.

Medicare Coverage for Virtual Colonoscopy

Although there are several factors that determine your cost without Medicare benefits, a virtual colonoscopy runs between $750.00 and $5,000.00. The average cost in the U.S. is $2,400.00. A standard colonoscopy has an average price tag of over $3,000.00.

As of now, Medicare does not offer coverage for a virtual colonoscopy. But, if you have Medicare benefits through Part B, you may have coverage for other types of colorectal cancer screening.

Medicare Part B preventive services include the following colorectal cancer screening exams:

• Screening fecal occult blood test is covered once every 12 months for individuals who are aged 50 and over.
• Screening flexible sigmoidoscopy is covered once every 48 month, or every 120 months after a previous colonoscopy.
• Screening colonoscopy is covered once every 120 months for individuals who are at an average risk or once every 24 months for those at high risk, or it is covered every 48 months after undergoing a flexible sigmoidoscopy.
• Screening barium enema is covered once every 48 months for individuals who are at an average risk or once every 24 months for high risk when a flexible sigmoidoscopy or colonoscopy are not being used for screening.

For the exams allowed through Medicare Part B preventive services, Medicare pays 100 percent of the cost with the following stipulations:

• For the fecal occult blood test, you must have a written referral from a health care provider.
• For the flexible sigmoidoscopy or colonoscopy, the health care provider performing the exams must accept Medicare assignment.

However, if during a colonoscopy the physician finds and removes abnormal tissue or polyps, you are responsible for 20 percent of the Medicare-approved amount for the physician’s services. You are also responsible for a copayment for the hospital as an outpatient.

For barium enemas you are responsible for 20 percent of the Medicare-approved doctor’s services but not for the Part B deductible. You may have to pay a copayment for the hospital as an outpatient.

Colorectal cancer accounts for around 8 percent of all newly diagnosed cancer cases annually in the United States. With early detection it is one of the most curable forms of cancer. Statistics show that if everyone eligible for a colonoscopy had one, close to 85 percent of all cases could be prevented or treated successfully.

Related articles:

Does Medicare Cover Cologuard? (Opens in a new browser tab)

Does Medicare Cover Cancer Treatment?(Opens in a new browser tab)