An important update on member cost-sharing for colonoscopies
Attention, primary care providers and gastroenterologists:
We’re aligning member cost-sharing with Medicare and industry standards for screening and diagnostic colonoscopies and sigmoidoscopies. We ask that you keep member cost-sharing in mind and discuss possible charges with your patient when referring or scheduling these services.
As a reminder, age-appropriate preventive screening colonoscopies and sigmoidoscopies are required to be covered without any member cost-sharing under the Affordable Care Act. A screening colonoscopy is typically done when someone has no symptoms and no previous history of colorectal cancer or polyps.
However, if you detect a polyp or other tissue during a screening colonoscopy or sigmoidoscopy that results in a biopsy or polyp removal, the screening test will be considered a diagnostic test. Diagnostic colonoscopies and sigmoidoscopies will incur member cost-sharing that could be up to $200.
Once a member has a history of colorectal cancer or polyps, all their future colonoscopies and sigmoidoscopies are considered diagnostic and will incur member cost-sharing.
Colonoscopies are among the most beneficial and most expensive preventive services recommended by the U.S. Preventive Services Taskforce. Be transparent with patients about the value of early detection and treatment of colorectal cancer as well as the cost of the services.