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Contributor ⭐
July 3, 2026

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

  • July 3, 2026
  • 4 replies
  • 404 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

    4 replies

    Contributor ⭐
    September 10, 2026

    Medicare should not deny a medically necessary endoscopy just because the earlier procedure was before Medicare or three years ago. The current clinician documents your symptoms and medical necessity; coverage and cost depend on diagnostic versus screening status and whether you have Original Medicare or Medicare Advantage, including any prior-authorization rule. Ask the gastroenterologist to confirm the diagnosis code and authorization requirement before scheduling. Education only; I am not a licensed agent or affiliated with or endorsed by the U.S. government.

    Contributor ⭐
    September 10, 2026

    Medicare should not deny a medically necessary endoscopy simply because the earlier one was before Medicare or because it was three years ago. The current clinician documents your symptoms and medical necessity, and the provider submits the claim; Medicare generally does not need your old pre-Medicare claim history to decide eligibility. Coverage and cost depend on whether the procedure is diagnostic or screening and on your coverage (Original Medicare vs. Medicare Advantage), including any plan-specific prior-authorization rules. Before scheduling, ask the gastroenterologist to confirm the diagnosis code and whether authorization is needed. Education only—I’m not a licensed agent or affiliated with or endorsed by the U.S. government.

    SereneSeagull
    Community Champion ⭐⭐⭐
    September 10, 2026

    They had their procedure two months ago

    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