Virtual colonoscopy, also called computed tomography colonography (CTC) or CT colonography, is a noninvasive way to check for polyps and colon cancer tumors. If you need a colonoscopy, you may wonder whether Medicare covers it.
Yes, beginning January 1, 2025, Medicare can cover virtual colonoscopies in specific circumstances. Medicare doesn’t cover them for initial colon cancer screenings.
The Centers for Medicare & Medicaid Services (CMS) announced expanding Medicare coverage for colorectal cancer (CRC) screening to include computed tomography colonography (CTC) — virtual colonoscopy.
Medicare covers virtual colposcopy mainly for pre-operative planning when imaging of the area of the colon near the obstruction is needed for treatment planning. It will not cover virtual colonoscopy only for screening.
CMS reports Medicare covers virtual colonoscopy when a traditional colposcopy cannot be performed due to:
- an obstructing neoplasm
- scarring, stricture, aberrant anatomy, or obstruction from prior surgery, radiation, or diverticular disease inside the colon
- compression from outside the colon
Medicare may also cover virtual coloscopy for you if you have one or more of these risk factors:
- a severe bleeding disorder
- long-term anticoagulation medication therapy
- increased risk of complications from sedation from severe chronic obstructive pulmonary disease (COPD)
- history of a previous adverse reaction to anesthesia
Medicare will not cover virtual colonoscopy if it’s used only for screening, if you have no signs or symptoms of disease, or if it’s used as an alternative to instrument colonoscopy for screening if you have no signs or symptoms of CRC.
One report suggested that in 2021, the average cost of a virtual colonoscopy without insurance was $610 in the United States.
The cost you pay for a virtual colonoscopy varies depending on your location and the Medicare plan you have. If you meet the circumstances for Medicare to cover the cost of your virtual colonoscopy, you could pay nothing since Medicare considers it a screening exam.
Virtual colonoscopy is becoming more widely acceptable as a tool for assessing and treating colorectal cancer. Beginning January 1, 2025, Medicare may cover virtual colonoscopy in specific circumstances. It is not covered for routine CRC screening.
Speak with your healthcare professional to check whether you’re the right candidate for this screening tool.
