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Colorectal Screening Tests and Medicare Coverage

Several tests can be used to detect polyps or colorectal cancer. Each one can be used alone. Sometimes they are used in combination with each other. People age 50 or older with Medicare are eligible for colorectal cancer screening. The exception: there is no minimum age for having a screening colonoscopy.

Fecal Occult Blood Test or Stool Test
You receive a test kit from your doctor or health care provider. At home, you put a small stool sample on a test card. You do this for three bowel movements in a row. Then you return the test cards to the doctor or a lab. The stool samples are checked for blood.
Medicare: Covered once a year. You pay nothing.

Flexible Sigmoidoscopy
The doctor puts a short, thin, flexible, lighted tube into your rectum. The doctor checks for polyps or cancer inside the rectum and lower third of the colon.
Medicare: Covers every 2 years. You pay 20% of approved amount after Part B deductible. If the flexible sigmoidoscopy is done in a hospital outpatient department, you pay 25% of the Medicare-approved amount after the yearly Part B deductible.

Fecal Occult Blood Test Plus Flexible Sigmoidoscopy
Your doctor may ask you to have both tests. Some experts believe that by using both, there is a better chance of finding polyps or colorectal cancer.
Medicare: See above.

Colonoscopy
This is similar to flexible sigmoidoscopy, except the doctor uses a longer tube to check for polyps or cancer inside the rectum and the entire colon. During the test, the doctor can find and remove most polyps and some cancers. You will be given medication to help you relax and are advised not to drive or work on the day of the exam.
Medicare: Covers every 10 years if you are not at high risk for colorectal cancer, but not within 4 years of having screening flexible sigmoidoscopy. Covers every 2 years if you are at high risk. There is no age limit for colonoscopy. You pay 20% of Medicare approved amount after yearly Part B deductible.

If the colonoscopy is done in a hospital outpatient department, you pay 25% of the Medicare-approved amount after the yearly Part B deductible.

Colonoscopy also may be used a as follow-up test if anything unusual is found during one of the other screening tests. Medicare covers follow-up colonoscopy.

Barium Enema
You are given an enema with a liquid called barium. Then the doctor takes an x-ray. The barium allows the doctor to see the outline of your colon on the x-ray to check for polyps or anything else that needs to be checked.
Medicare: Your doctor may order this test as a substitute for flexible sigmoidoscopy or colonoscopy. It is covered every 4 years if you are not at high risk or covered every 2 years if you are at high risk for colorectal cancer. You pay 20% of approved amount after the yearly Part B deductible.

More Information:
For more information about Medicare coverage, call 1-800-MEDICARE (1–800–633–4227). TTY users should call 1–877–2048. Or visit www.medicare.gov.

For more information about colorectal cancer and screening, visit CDC Cancer Prevention and Control or call the National Cancer Institute's Cancer Information Service: 1–800–4–CANCER. For TTY call 1–800–332–8615.

Last Review: Friday, February 26, 2010

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Colorectal Screening Tests and Medicare Coverage