Does Medicare Pay for Endoscopy?

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  • Does Medicare pay for endoscopy? Endoscopy is a less-invasive medical procedure that’s performed millions of times a year. Find out how Medicare helps pay for this procedure.

Endoscopy is generally performed as an outpatient procedure, which puts it in the category of services Medicare covers under traditional Part B benefits. Medicare Advantage plans provide the same benefit, which are provided for under the standard Medicare limits.

What Is Endoscopy?

Endoscopy is a diagnostic procedure that involves inserting a flexible probe into the digestive tract so that a doctor can look at its lining with a small camera. Endoscopes may be inserted into the upper or lower GI tract to look for different conditions, and a special procedure can be done that takes images of the pancreas and gallbladder. Endoscopy is a nonsurgical procedure that can usually be done in a doctor’s office.

Why Endoscopy?

Your doctor might order an endoscopy for you for several reasons. An endoscopic examination helps identify ulcers, polyps and some types of cancer. The doctor can use endoscopy to supplement various other diagnostic tests and identify problems of the gallbladder, stomach and pancreas. Because the scope used for endoscopy develops a real-time color image of the lining of your GI tract, it can be used to spot multiple potentially serious health conditions.

How Much Does Endoscopy Cost?

Paid for out of pocket, a typical endoscopy in the United States costs an average of $2,750. Depending on where and how you have the procedure, as well as the details of which parts of your GI tract are being examined and whether the procedure is done in a doctor’s office or hospital, the price can range between $1,250 and $4,800.

How Does Medicare Pay for Endoscopy?

Because it is usually categorized as an outpatient diagnostic procedure, endoscopy is included under Original Medicare’s Part B outpatient coverage. This means that Medicare can pay up to 80% of the cost of your procedure after you have met the $203 annual deductible for 2021.

If you have Medicare Advantage, which is sometimes called Medicare Part C, your coverage is probably similar to what Original Medicare participants have.

By law, all authorized Part C plans must include the same tests and procedures as Parts A and B, with the same coverage costs and coverage minimums. Medicare Advantage plans are issued by private insurance companies, which are free to offer additional coverage that goes beyond what Original Medicare can provide. Ask a plan representative from your issuer for details about coverage for endoscopy.