Medicare Coverage for Colon Cancer Screenings

CURE, Summer 2007, Volume 6, Issue 4

What does Medicare cover when it comes to screening for colorectal cancer?

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Benefits for individuals of average risk, age 50 or older:Fecal occult blood test (FOBT), every 12 months

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Flexible sigmoidoscopy, every 48 months

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Screening colonoscopy, every 10 years (no minimum age)

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Barium enema, an alternative to flexible sigmoidoscopy or colonoscopy if your physician determines its screening value is equal or better

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Benefits for high-risk* individuals, regardless of age: FOBT, every 12 months

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Sigmoidoscopy, every 48 months

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Colonoscopy, every 24 months

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Barium enema, every 24 months

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What you’ll pay: FOBT, completely covered by Medicare

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Flexible sigmoidoscopy, colonoscopy or barium enema, 20 percent of Medicare-approved amount after yearly Part B deductible if done in a doctor’s office (and 25 percent for a flexible sigmoidoscopy or colonoscopy done in a hospital outpatient department)

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*You’re high risk if you have:previously had colorectal cancer

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a close relative with colorectal polyps or cancer

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a history of polyps

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inflammatory bowel disease

For information about Medicare coverage of cancer screenings and about risk factors, visit www.medicare.gov/Health/cancer.asp. To learn about the Welcome to Medicare visit, see www.medicare.gov/health/physicalexam.asp.