Medicare recipients with certain digestive system problems may undergo an endoscopy to help a physician determine the cause of symptoms. Getting an appropriate diagnosis can be essential for treating disorders of the esophagus, stomach, and small intestine.

The Endoscopy Procedure

During an endoscopy procedure for the upper GI tract, a doctor passes a flexible tube down your throat, typically through your mouth. This tube, the endoscope, has both a camera and a light. The light lets the doctor get a good look at your esophagus, stomach, and upper intestine. The camera transmits the images to a screen in real-time as the endoscope moves down your GI tract.

As a general rule, an endoscopy is used to help identify the cause of problems in your gastrointestinal tract, such as:

• Bleeding
• Stomach pains
• Ongoing difficulties swallowing
• Chronic constipation or diarrhea
• Suspected ulcers or gastritis

In some cases, the doctor can also use the endoscope to collect biopsies or treat certain conditions by passing small tools down through the endoscope.

Endoscopy Risks
On the whole, endoscopy procedures are very low risk. There is a small possibility of bleeding or infection, or you could respond poorly to the sedation. While possible, most people don’t experience any of these problems during an endoscopy.

Will Medicare Cover the Endoscopy?
An endoscopy falls into the category of an outpatient procedure. That means that it is usually covered under Medicare Part B, the part of Medicare devoted to outpatient medical treatments and diagnostic procedures. If your doctor determines that the procedure is medically necessary, Medicare Part B may help cover the costs.

If you have Part B and your procedure has been approved by Medicare, Part B will cover 80% of the cost of your care as long as you visit a Medicare-approved doctor who accepts assignment. The Part B deductible will apply.

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