We receive many questions regarding the difference between a screening and a diagnostic colonoscopy procedure.

It is important to understand the difference between a screening and diagnostic colonoscopy screening. It is imperative that you talk to your insurance company regarding your benefits and their criteria, as this can have an effect on your out-of-pocket costs such as deductibles and/or coinsurance. Most insurance plans will cover screening colonoscopy, while diagnostic will be applied to your deductible and/or coinsurance.

Screening Colonoscopy Factors

  • No symptoms before the procedure
  • No finding during the procedure (polyps, diverticulosis, etc.)
  • No personal family history of cancer or polyps
  • No family history of cancer or polyps (some insurances consider this high risk)

Diagnostic Colonoscopy Factors

  • Symptoms before the procedure such as change in bowel habits, rectal bleeding, abdominal pain, etc.
  • Findings during the procedure (polyps, cancer, diverticulosis, etc.)
  • Personal history of cancer or polyps
  • Family history of cancer or polyps (some insurances consider this high risk)

Important Note: Regional Gi follows appropriate coding guidelines and procedures. A screening procedure may become diagnostic based on findings during colonoscopy or symptoms you are experiencing.

The points noted above are to be used for informal purposes only, as insurance and benefits criteria vary by plan.

If you have any questions or concerns, please contact your insurance company to verify your benefits and out-of-pocket costs for your screening or diagnostic colonoscopy.

Feel free to share the attached PDF.