Does Medicare Cover Colonoscopy and Endoscopy?

A colonoscopy examines the large intestine, including the colon, rectum, and anus, using a flexible tube with a camera. This procedure detects and prevents colorectal cancer and diagnoses gastrointestinal diseases by identifying issues like polyps, ulcers, or inflamed tissue.

An endoscopy views the interior of organs, most commonly the upper gastrointestinal tract (esophagus, stomach, and small intestine), using a thin, flexible tube with a light and camera. It diagnoses symptoms such as abdominal pain, difficulty swallowing, or gastrointestinal bleeding, and can remove polyps or take tissue samples. Medicare covers these procedures, though specifics and costs vary.

General Medicare Coverage Principles

Medicare offers healthcare coverage through Original Medicare and Medicare Advantage plans. Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers inpatient hospital stays, skilled nursing facility care, and some home health services. Part B covers outpatient services, doctor’s visits, preventive care, and certain medical supplies and equipment.

Medicare Advantage (Part C) plans are private alternatives to Original Medicare. They must provide at least the same benefits as Original Medicare Part A and Part B, but may have different cost-sharing and additional benefits like prescription drug coverage. Understanding the distinction between “screening” and “diagnostic” procedures is important for Medicare coverage. Screening procedures detect potential health issues before symptoms appear, while diagnostic procedures investigate existing symptoms or abnormal findings.

Colonoscopy Coverage Details

Medicare Part B covers colonoscopies, with specific rules for screening versus diagnostic procedures. For screening colonoscopies, performed when a person has no symptoms, Medicare Part B covers the full cost. This 100% coverage applies if the healthcare provider accepts Medicare assignment, and the Part B deductible does not apply.

The frequency of covered screening colonoscopies depends on colorectal cancer risk. For average-risk individuals, Medicare covers a screening colonoscopy once every 10 years, or 48 months after a flexible sigmoidoscopy. For high-risk individuals, Medicare covers screening colonoscopies once every 24 months. If polyps or other tissue are found and removed during a screening colonoscopy, the procedure may be reclassified as diagnostic. In such cases, the Part B deductible does not apply, but the individual may owe a coinsurance amount, typically 15% of the Medicare-approved amount.

When a colonoscopy is a diagnostic procedure due to symptoms or abnormal findings, Medicare Part B covers it, and standard cost-sharing rules apply. After the Part B deductible is met, the individual is responsible for 20% coinsurance of the Medicare-approved amount. While most colonoscopies are outpatient procedures covered by Part B, if performed during an inpatient hospital stay meeting specific Medicare criteria, it may be covered under Medicare Part A.

Endoscopy Coverage Details

Endoscopies, such as upper GI endoscopies, are covered by Medicare as diagnostic procedures, not routine screenings. Medicare Part B coverage requires the procedure to be medically necessary. A doctor must order it to investigate specific symptoms like difficulty swallowing, chronic stomach pain, nausea, vomiting, or gastrointestinal bleeding.

For diagnostic endoscopies, Medicare Part B covers the doctor’s services, facility fees, and anesthesia. After the annual Medicare Part B deductible is satisfied, individuals are responsible for 20% of the Medicare-approved amount.

If an endoscopy is performed during an inpatient hospital stay, Medicare Part A may cover the costs. In such inpatient scenarios, the Part A deductible ($1,676 in 2025) would apply. Confirm with your healthcare provider and Medicare plan whether the procedure is inpatient or outpatient, as this impacts coverage and costs.

Understanding Your Out-of-Pocket Costs

Understanding your out-of-pocket costs for medical procedures under Medicare involves various cost-sharing elements. For services covered by Medicare Part B, such as diagnostic endoscopies and certain diagnostic colonoscopies, the annual deductible applies. In 2025, the Part B deductible is $257, which must be paid before Medicare covers its share. After the deductible is met, individuals are responsible for 20% coinsurance of the Medicare-approved amount for most covered outpatient services.

Medicare Advantage (Part C) plans are an alternative to Original Medicare. While they must cover the same services, their cost-sharing can differ. These plans may have varying copayments, coinsurance, and deductibles for colonoscopies and endoscopies, plus network restrictions. Individuals enrolled in a Medicare Advantage plan should contact their plan to understand their exact out-of-pocket costs and ensure providers are in-network.

For those with Original Medicare, Medigap (Medicare Supplement Insurance) plans can help cover out-of-pocket expenses like the Part B deductible and coinsurance. The extent of this coverage depends on the specific Medigap plan. Before scheduling a colonoscopy or endoscopy, verify coverage and estimated costs with your healthcare provider and Medicare plan. Ask for a detailed cost estimate and confirm all involved providers accept Medicare assignment to prevent unexpected charges.