Medicare coverage for colonoscopy depends on the purpose of the procedure and the specific circumstances. Here's a breakdown of how different parts of Medicare may cover colonoscopy:
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Medicare Part A: Hospital Insurance typically covers colonoscopy services when performed as an inpatient procedure. If you undergo a colonoscopy while admitted to a hospital, Part A may cover the associated costs.
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Medicare Part B: Medical Insurance covers colonoscopy services when performed as an outpatient procedure. Part B generally covers both screening and diagnostic colonoscopies.
a. Screening colonoscopy: Medicare Part B covers screening colonoscopies once every 24 months for individuals considered to be at high risk of developing colorectal cancer. If you're not at high risk, Medicare covers a screening colonoscopy every 120 months (10 years). The screening colonoscopy is usually covered at 100% of the Medicare-approved amount.
b. Diagnostic colonoscopy: Medicare Part B also covers diagnostic colonoscopies if a doctor recommends the procedure to evaluate specific symptoms or conditions. In these cases, the coverage may be subject to the usual Part B deductible, coinsurance, and copayment requirements.
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Medicare Part C: Medicare Advantage plans (Part C) must provide at least the same coverage as Original Medicare (Part A and Part B). Therefore, Medicare Advantage plans should cover colonoscopy services, including screening and diagnostic colonoscopies. The coverage details may vary depending on the specific plan.
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Medicare Part D: Prescription Drug Plans (Part D) do not directly cover colonoscopy procedures. Part D plans primarily cover prescription medications.
It's important to note that coverage may vary based on individual circumstances and specific Medicare plans. Before undergoing a colonoscopy, it's recommended to contact your healthcare provider and Medicare directly to understand your coverage and any potential costs associated with the procedure.
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