Insurance & Screening Coverage Guide

Action: Know that screening should be covered.
Most adults should start screening at age 45 and continue regularly through age 75. These recommendations come from the U.S. Preventive Services Task Force and many plans must cover recommended preventive services without out of pocket costs when you use in network care.

Ask your plan: “Can you confirm that colorectal cancer screening is covered without cost sharing when I use an in network provider.”

Action: If a stool test is positive, schedule a colonoscopy right away.
The colonoscopy completes your screening. Federal guidance says most private plans must cover this follow up colonoscopy with no cost sharing when done in network.

If you have Medicare:
Medicare now treats a colonoscopy after a positive Medicare covered stool test as part of screening. Medicare is also phasing down coinsurance when additional procedures are done during a screening colonoscopy. Clinics use specific claim modifiers to help your claim process correctly. Ask your clinic how they will bill your visit. 

Say to your clinic scheduler: “I am completing colorectal cancer screening. I had a positive stool test. This is the preventive follow up colonoscopy covered by my plan.” 

Action: Prevent surprise bills with clear notes and questions.
Write “screening follow up colonoscopy” on your paperwork and calendar. If you receive a bill that seems wrong, call your plan and clinic and ask for a preventive review. Screening uptake rose after the age was lowered to 45, but gains have been uneven by geography and socioeconomic status. We work to close these gaps. JAMA Network 

Tools and Resources 

Action: To learn more check out the following resources.  

• USPSTF Colorectal Cancer Screening ages 45 to 75, options and intervals. USPSTF 
• Preventive Services Coverage Basics explanation that many private plans must cover recommended preventive services with no cost sharing. 
• Medicare policy you can share with your clinic follow on colonoscopy is part of screening and coinsurance is being phased down when additional procedures occur. 
• Fight CRC Follow Up Colonoscopy Toolkit (Guide for Insurance Companies and Clinics): Share this with your plan administrator or clinic billing team to support accurate coverage and coding for follow-up colonoscopies.
• Fight CRC Follow Up Colonoscopy Toolkit (Guide for Providers): Outlines clinical and administrative best practices to ensure follow-up colonoscopies are properly classified and covered as part of screening.
• Fight CRC Follow Up Colonoscopy Tookit (Guide for Patients): Explains your rights to coverage for follow-up colonoscopies and provides steps to take if you receive an unexpected bill.

Still have questions? Open Fight CRC’s Chat CRC to get answers.  

We helped secure clear federal guidance that a follow up colonoscopy after a positive stool test is part of screening. We provide practical toolkits and push for patient friendly communication so claims are paid correctly.  

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