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Old 10-15-2012, 12:01 PM   #21
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Originally Posted by DFW_M5 View Post
I am a little confused by the nurses comment. Is she saying you will only receive one colonoscopy screening under medicare for life. I hope that is not the case, because many that have had polys are on 3 or 5 year rechecks, otherwise the risk of colon cancer can go way up and if the patient is fully responsible after the first one, that could lead to some big out of pocket expense over one's remaining life.

Edit: Seems your nurse may not be totally correct, see Colorectal cancer screenings |, looks like there could be some out of pocket, but its not clear if that applies if you are at risk for colon cancer
Actually it was my doc's billing specialist who does the coding. Apparently the big difference is if the colonscopy is a screening (requires no prior polyps) or a follow-up for a diagnosed condition. As she explained it, it would appear the screening is covered per the link above. However, if a prior exam had a polyp removal than the charges moved to a different coding and an out of pocket expense.
The billing specialist indicated that the annual physical and preventive care available under pre-medicare insurance was not covered in the same way after the first year list of "preventive care" treatments that include a one time well health physical and colonscopy. She did emphasize that you must get these preventive care services done before your first anniversary on medicare.
Perhaps some of our medical types can weigh in here.

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Old 10-15-2012, 01:49 PM   #22
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Thanks Steve. I really need to understand this since I'll be on Medicare in 1.5 years and have been subject to benign, but pre-cancerous polyps being discovered during my past two colonoscopys. Therefore, my Dr sees some risk for me to get colon cancer and has me on a 3 year schedule for repeat colonoscopy.

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