Understanding Colonoscopy Categories and Insurance Coverage

The Affordable Care Act, passed in March 2010, allows for several preventive services, such as colonoscopies, to be covered at no cost to patients. However, strict guidelines are used to define the type of colonoscopies our physicians perform: preventive (screening), diagnostic, or surveillance. Even if your primary care physician has recommended that you get a screening colonoscopy, ‘screening’ may not be the category ultimately assigned to your procedure.

To help you better understand the different categories and how your insurance benefits may be applied, please read the following document.  It explains how your scheduled colonoscopy will be defined based on the various CPT medical codes and how your insurance company, Medicare, or Medicaid will interpret those codes.