Released on Jan 17, 2022

New Cost-Sharing Guidance for Colonoscopies After Other Positive Screening Tests

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.


About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with almost 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit Asge.org and ValueOfColonoscopy.org for more information and to find a qualified doctor in your area.

 

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Media Contact

Andrea Lee
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ALee@asge.org