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Medicare pays for many preventive services in order to aid you in staying healthy. Preventive services can find problems early and can help keep you from getting certain diseases or illnesses. These services include exams, lab tests, and screenings. One of these services is the colorectal cancer screening.
What is Colorectal Cancer?
Colorectal cancer, sometimes called colon cancer, is cancer that occurs in the colon or rectum. The colon is the large intestine or large bowel. The rectum is the passageway that connects the colon to the anus. Colorectal cancer is one of the leading cancer killers in the United States. However, colorectal screening can help to save lives.
What is Colorectal Cancer Screening?
Colorectal cancer screening finds precancerous polyps (abnormal growths in the colon or rectum) so that they can be removed before turning into cancer. Screening can also help find the cancer at an early stage, so that treatment can be started. Early treatment can often cure colorectal cancer. Several types of screening methods exist. Your doctor can help you to determine which type of screening is best for you. You may experience several types of screenings during different times of your health care coverage.
Common screening procedures include:
- Barium enema – This is an X-ray of the colon using liquid barium and, sometimes air, inserted into the colon.
- Colonoscopy – This procedure uses a colonscope (long, flexible tube) inserted into the rectum. A tiny video camera allows the doctor to view the inside of the entire colon.
- Fecal occult blood test – This test chemically checks the stool for hidden (occult) blood. However, it is a rather insensitive method for detecting colon cancer and should be combined with another method.
- Flexible sigmoidoscopy – This procedure uses a sigmoidoscope (a thin, flexible tube) inserted into the rectum. A tiny video camera allows the doctor to view the inside of your sigmoid colon and rectum (about the last 2 feet of the intestine). Unlike the colonoscopy, the flexible sigmoidoscopy does not see the entire colon.
- Virtual colonoscopy (computerized tomography (CT) colonography) – This procedure uses a CT scanner to produce hundreds of cross-sectional images of your abdominal organs.
Does Medicare Cover Colorectal Cancer Screening?
Medicare Part B covers colorectal cancer screening to help find precancerous polyps. Colorectal cancer screening guidelines vary for each procedure.
- Barium Enema is covered once every 48 months when used instead of sigmoidoscopy or colonoscopy. If you are considered high risk, Medicare will cover this procedure every 24 months.
- Screening Colonoscopy is covered once every 120 months. If you are considered high risk, Medicare will cover this procedure every 24 months.
- Fecal Occult Blood Test is covered once every 12 months.
- Flexible Sigmoidoscopy is generally covered once every 48 months. When this procedure is used instead of a colonoscopy it is covered once every 120 months.
- Virtual colonoscopy (computerized tomography (CT) colonography) does not yet have standard Medicare coverage. Each Medicare program decides how or if it is covered. You will need to discuss this with your doctor to see if this procedure is recommended and covered.
Do I Qualify for a Colorectal Cancer Screening? What Do I Pay?
All people with Medicare coverage (any age) qualify for the screening colonoscopy procedure. Those Medicare beneficiaries age 50 and older are covered for ALL types of colorectal screening procedures.
For the fecal occult blood test, you will pay nothing. For all other tests, you pay 20% of the Medicare-approved amount. However, if the colonoscopy or flexible sigmoidoscopy is performed in a hospital outpatient department or an ambulatory surgical center, you will have to pay 25% of the Medicare-approved amount. You do NOT have to pay the Part B deductible for any colorectal cancer screening. You will, however, have to pay the coinsurance.
What is my risk for colorectal cancer?
Risk for colorectal cancer increases with age. Your risk may increase if:
- You have had colorectal cancer before, even if it has been completely removed.
- You have a close relative, such as a sister or brother, parent or child, who had colorectal polyps or colorectal cancer.
- You have a history of polyps.
You have inflammatory bowel disease (like ulcerative colitis or Crohn's disease).
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