All in-network preventive services, including screening colonoscopies, are covered at no charge. Diagnostic colonoscopies are also covered but require a member pay their deductible and coinsurance. Providers determine which type of testing is appropriate based on factors such as a patient’s history, other tests and current symptoms and complaints. Payment for colonoscopy services is driven by the provider’s billing.
Under current coverage guidelines, a screening colonoscopy every ten years is considered medically necessary for asymptomatic individuals age 50 or older. If medically necessary, due to certain risk factors, screening may begin at an earlier age and occur more frequently.