Does Medicare Cover an Upper GI? 

Digestive concerns are common among seniors. Your diet, medications, and other medical conditions can affect the gastrointestinal (GI) tract. Side effects of GI problems can range from mildly irritating to life-threatening. For most seniors, GI concerns require a visit with a family physician to be checked out. If your doctor is unable to easily diagnose or treat a GI condition, you may be sent to a gastroenterologist.

A gastroenterologist is a medical specialist who treats GI concerns exclusively. These doctors have special training to identify and treat disorders of the digestive system, including those affecting the stomach, liver, pancreas and intestines.

If your gastroenterologist believes you have an internal GI problem that warrants further investigation, they may order medical imaging. Another type of test that is commonly used by gastroenterologists is an upper GI exam, also known as an endoscopy.

What is an upper GI exam?

An upper GI exam involves inserting a long, flexible, remotely-controlled endoscope down your throat. A camera is attached to the end of this scope that broadcasts images to a monitor that is used by your gastroenterologist to guide the procedure.

In most cases, seniors who require an upper GI exam will be sedated. You will not be awake for the procedure, and you will likely have little recollection of the event afterward. In some cases, your gastroenterologist may need to take small tissue samples or perform other procedures during the endoscopy exam.

Does Medicare cover an upper GI?

Medicare covers upper GI exams under Medicare Part B when these procedures are performed in an outpatient setting. When an upper GI is performed during a hospital admission, Medicare Part A provides coverage instead.

Under Medicare Part B, the outpatient portion of Medicare benefits, Medicare recipients pay a 20% coinsurance for the procedure. If an endoscopy is performed while you are admitted to a Medicare-participating hospital or skilled nursing facility, Medicare benefits cover all services as long as you are within the 60 days of allotted hospital care coverage for the benefit period (only 20 days are allotted for full coverage in a skilled nursing facility each benefit period).

Your costs for an upper GI under Medicare insurance

Medicare Part B costs include a monthly premium and the aforementioned 20% coinsurance. You will also need to meet your plan’s deductible before Medicare benefits apply toward an upper GI or any other outpatient services. In 2024, the standard deductible for Medicare Part B is $240, and Medicare Part B premiums start at $174.70 per month but can be as high as $594 per month depending on your income level.

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