Last week the U.S. Departments of Health and Human Services, Labor and Treasury issued new guidance on coverage of colonoscopies for those with private health insurance.

Pursuant to updated recommendations on colorectal cancer screening issued by the U.S. Preventive Services Task Force (USPSTF) last year, the new guidance requires group health plans and health insurance issuers to cover, without the imposition of any cost sharing, a follow-up colonoscopy conducted after a positive non-invasive stool-based screening test or direct visualization test (e.g., sigmoidoscopy, CT colonography).

In the 2021 recommendations, the USPSTF stated the follow-up colonoscopy is an integral part of the preventive screening without which the screening would not be complete. The Departments therefore concluded the follow-up colonoscopy after a positive non-invasive stool-based screening test or direct visualization screening test is required to be covered without cost sharing in accordance with the Affordable Care Act.

Health plans and issuers must provide coverage of follow-up colonoscopies without cost sharing for plan or policy years beginning on or after May 31, 2022.

“Colonoscopy remains the most effective screening test for colorectal cancer and polyps, and the only test effective enough to be done only once every 10 years,” said Douglas Rex, MD, MASGE, ASGE President. “But not everyone is willing to undergo screening colonoscopy and some do not have access to it.  These individuals should undergo one of the fecal tests. If these tests are positive they must be followed by colonoscopy, and this new guidance removes an important barrier to getting these essential follow-up colonoscopies completed.”

Over the years, ASGE has worked with policymakers to knock down barriers to colorectal cancer screening and is committed to improving screening rates and eliminating inequities in colorectal cancer screening among minority and medically underserved populations. ASGE applauds the updated guidance as yet another step toward removing financial barriers to screening. In 2020, ASGE celebrated the passage of the Removing Barriers to Colorectal Cancer Screening Act which eliminated Medicare beneficiary cost sharing for a colonoscopy that turns diagnostic during the screening encounter.