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db58528269
Contributor ⭐
July 3, 2026

Will medicare check on pre-medicare medical history for a possible upper endoscopy.

  • July 3, 2026
  • 1 reply
  • 155 views

I am having a colonoscopy this month. My last one was five years ago so I’m not expecting any insurance hassles. I had an upper endoscopy three years ago but I have since developed issues from lung to nasal passages. I’d like to get another endoscopy but I’m wondering if medicare will deny since it has only been three years. Will they even know since I wasn’t in medicare program at the time? Thanks

    1 reply

    GailL1
    GailL1
    Community Champion ⭐⭐⭐
    July 3, 2026

    @db58528269 

    Both test would be covered if medically necessary

     

    The Colonoscopy would  be covered either as preventive or diagnostic depending why you are having it at this interval - Preventive is covered as NO out of pocket cost to you but diagnostic would be at the regular Part B rate so that is gonna depend on your risk factor (see the link). 

    .Medicare.gov - Colonoscopies (Screening)  

     

    The endoscopy can be used for either diagnostic or sometimes theraputic reasons and it would be covered under the regular Part B payment schedule.  You pay your part (or have it paid for you if you have a Medigap policy) and Medicare pays their part. 

     

    CMS.gov National Coverage Determination - Endoscopy 

     

     

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