Colorectal Cancer Screening Medicare Changes Coverage Policy
As of 2022, colorectal cancer is the third leading cause of cancer-related deaths in both men and women and the second overall when men and women are combined. It is the third most common cancer diagnosis in men and in women in the USA. The majority of this type of cancer is found in people older than 50, however, colorectal cancer is on the rise in young adults and has been for years.
Effective January 1, 2023, Medicare has changed its policy coverage for colorectal screening and reduced the patient responsibility. Coverage includes:
- Minimum age for colorectal cancer screening tests from 50 to 45 years old.
- Reduction in coinsurance when screening colorectal cancer becomes diagnostic or therapeutic. Services provided Jan 1, 2023, thru Dec 31, 2026, coinsurance will be 15% for all procedures listed below and billed on the same claim. Colorectal cancer procedure codes G0104, G0105, or G0121 with codes 10000-69999, G0500, 00811 or 99153 for a diagnostic colonoscopy, diagnostic flex sig, or other procedure.
- No deductible applies for all surgical procedures furnished on the same date and in the same encounter as the screening coloscopy, flex sig, or barium enema.
- Colorectal cancer screening tests include a follow-on screening colonoscopy if a non-invasive stool-based test returns a positive result.
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