Watch Age and Frequency Limits for Medicare Colonoscopy
Screenings
Medicare benefits allow a covered screening colonoscopy once every 24 months for those patients defined as “high risk” for colorectal cancer, or once every ten years — but not within 48 months of a screening sigmoidoscopy — for those patient’s who do not qualify as “high risk.”
In addition, Medicare guidelines generally require that a screening exam is a covered benefit for those beneficiaries at low risk for colorectal cancer who are 50 years of age or older. This can vary, however, and some carriers specify medical-necessity requirements that allow low-risk beneficiaries under age 50 to receive a covered screening exam.
For beneficiaries at high risk for colorectal cancer, national Medicare policy does not set a minimum age requirement. CMS MedLearn Matters article SE0613 states, “For beneficiaries considered to be at high risk for developing colorectal cancer, Medicare covers one screening colonoscopy every two years, regardless of age.”
Turn to ABN When Exceeding Frequency Limits
Medicare benefits allow a covered screening colonoscopy once every 24 months for those patients defined as “high risk” for colorectal cancer, or once every ten years — but not within 48 months of a screening sigmoidoscopy — for those patient’s who do not qualify as “high risk.”
In addition, Medicare guidelines generally require that a screening exam is a covered benefit for those beneficiaries at low risk for colorectal cancer who are 50 years of age or older. This can vary, however, and some carriers specify medical-necessity requirements that allow low-risk beneficiaries under age 50 to receive a covered screening exam.
For beneficiaries at high risk for colorectal cancer, national Medicare policy does not set a minimum age requirement. CMS MedLearn Matters article SE0613 states, “For beneficiaries considered to be at high risk for developing colorectal cancer, Medicare covers one screening colonoscopy every two years, regardless of age.”
Turn to ABN When Exceeding Frequency Limits
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