The cost varies based on whether it is a screening or diagnostic exam and the patient’s insurance plan. Since these factors can significantly impact the patient’s financial responsibility, I wanted to provide some insight into why some colon cancer screenings are coded differently than others.
- A screening colonoscopy is for those over the age of 45 with no symptoms (either past or present) and without a personal or family history of gastrointestinal disease, colon polyps, or cancer. Insurance will typically cover 100% of the cost of a screening exam once every 10 years beginning at age 45.
- A colonoscopy is classified as diagnostic if the patient has a past or present history of gastrointestinal symptoms or disease, polyps, or cancer.
Physicians have been fighting with insurance providers for years over these distinctions and the varying costs, but we are bound to specific coding guidelines. Other factors that can affect the cost of the procedure are facility fees, lab fees for a biopsy if needed, and anesthesia. I recommend discussing with your doctor and insurance provider these factors to make sure that you have a clear understanding of all expenses prior to the procedure.
I’m proud that our endoscopy center has one of the lowest facility fees in the Dallas area, which provides value to our patients. Offering expert healthcare while maintaining competitive pricing for our patients is important to my practice and the entire group of physicians at the Digestive Health Associates of Texas.
REMINDER: If you call a doctor’s office to schedule a colonoscopy and mention that you need the exam due to symptoms, it will be coded as a diagnostic exam. It’s important to clarify with your doctor the reason for the exam prior to calling the gastroenterologist’s office to schedule.