Upper gastrointestinal (GI) endoscopies are procedures that are commonly used to look at the upper portion of the intestinal tract, including the throat, esophagus, stomach, and initial portion of the small intestine. Upper GI endoscopies can help to diagnose medical conditions, allowing healthcare professionals to treat them. As long as this procedure is deemed to be medically necessary, your Medicare benefits will most likely cover its cost under Original Medicare Part A or Part B or your Medicare Advantage Plan.

What is an Upper GI Endoscopy?

These procedures are often done on an outpatient basis and involve placing a thin, flexible scope into the mouth and down the throat. This scope has a camera and a light on the end of it so that it can visualize the inside of the upper gastrointestinal tract and take photographs for documentation.

An upper GI endoscopy looks at the throat, esophagus, stomach, and duodenum. The duodenum is the first portion of the small intestine. If the latter portions of the small intestine, large intestine, or colon need to be examined, a colonoscopy will most likely be used instead. This involves the same procedure, but it starts from the anus instead of the mouth.

Upper GIs can be done in outpatient settings or hospitals to identify and treat medical conditions, find the source of pain or infection, examine swallowing disorders, or discover bleeding or ulcers. Along with the camera and light, other small tools can also be inserted in order to fix some of the problems that may be discovered.

If a tissue mass or other abnormality is noted, a tissue biopsy, or sample, may be taken for further investigation. Other tools can be inserted to remove particles of food or other objects that may be stuck at various points in the GI tract. Air or fluid may be injected to clean off tissues, and laser therapy may also be used to open up the GI tract.

Before the procedure begins, your healthcare provider will discuss the procedure with you, address any concerns you may have, and have you sign a consent form. They will also confirm your allergies and ask what medications you are currently taking. This is especially important if you are taking any blood thinners that make it more difficult for your blood to clot. This can be cause for concern because you will be at higher risk of bleeding, and if bleeding does occur, it will be more difficult to stop.

You will also have to be sure that your entire bowel is clear and unobstructed so that the procedure can be carried out effectively. This often involves not eating for a certain number of hours prior to the surgery, and you may also be required to take a laxative, enema, or suppository to help clear everything out.

Upper GI endoscopies do not require you to be put under full anesthesia, but you will be given a sedative to help you relax. Because of the sedative, you will need someone else to drive you home following the procedure.

Do Medicare Benefits Cover the Cost of Upper GI Endoscopies?

Medicare coverage for endoscopies depends on where the procedure takes place. If you have Original Medicare and the procedure occurs during an inpatient hospital stay, Medicare Part A will cover the costs. This often doesn’t involve a premium payment, but you will most likely have to pay out-of-pocket until you reach your deductible.

If the upper GI takes place in an outpatient facility, Medicare Part B will cover the costs. Part B requires a monthly premium payment, out-of-pocket payments until your deductible is reached, and that you pay 20 percent of the Medicare-approved amount of the procedure. If you have a Medicare Advantage Plan, it is likely that the procedure will be covered. However, it is important to check with your specific policy to see the total cost you would incur from the procedure.

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