Does Medicare Cover an Endoscopy?

An endoscopy is a non-surgical procedure doctors use to examine a person’s digestive tract.

The procedure uses an endoscope, which is a flexible tube with a small camera on the end of it. This tube and camera are then inserted in an opening, either your mouth or anus. The doctor can then view the video from the camera to examine the digestive tract.

Undergoing an endoscopy can be quite expensive and not everyone who needs one can afford it.

So a common question many people have is, “Does Medicare cover an Endoscopy?” In this article, we answer the question in clear, plain English. You will also find the average costs of an endoscopy and other helpful info.

Does Medicare Cover an Endoscopy?

The short answer is yes; Medicare will cover the cost of an endoscopy. But not 100% of the time. As is often the case with Medicare, certain conditions must be met in order for Medicare to pay for your endoscopy. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for an endoscopy. Coverage for an endoscopy is provided by Medicare Part A if it takes place in an inpatient setting as part of the care you receive there.

But most of the time, an endoscopy will take place in an outpatient setting. And that means that coverage usually falls under Medicare Part B.

There are two types of endoscopy procedures. They are endoscopy and colonoscopy.

The “regular” endoscopy, also known as upper endoscopy, passes through the mouth to examine the following:

The esophagus
The stomach
The small intestine

A lower endoscopy is more commonly known as a colonoscopy. In this procedure, the endoscope will enter through the colon into the large intestine.

Medicare Part B provides coverage for a colonoscopy once every two years if you are at a high risk of having colon cancer. If you previously have had a flexible sigmoidoscopy, Medicare may provide coverage once every 4 years.

However, if you are 50 or older, Medicare Part B may provide coverage for a flexible sigmoidoscopy once every two years.

Things are different if you are not at high risk of developing colon cancer. In this case Medicare will provide coverage for a colonoscopy or a flexible sigmoidoscopy once every 10 years.

For Medicare to provide coverage for your endoscopy, your healthcare provider must order it for a medically necessary reason. If your healthcare provider accepts Medicare assignment, Medicare will cover the costs of your colonoscopy or screening flexible sigmoidoscopy in full.

Medicare Advantage for Endoscopy

Medicare Advantage plans (Medicare Part C) also provide coverage for an endoscopy. They cover everything Original Medicare covers but also usually offer some additional benefits. However, exactly what it covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan.

How Much Does An Endoscopy Cost?

The average cost of endoscopy is nearly $2,500. The range goes from a low of around $1,000 to a high close to $5,000. What type of facility you get the endoscopy at and where you live will affect the price you end up paying.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.